Outcomes of 24 patients with subarachnoid hemorrhage aged 80 years or older in a single center

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Abstract

Objective

In the developed countries, elderly population is rapidly increasing, but outcomes of elderly patients with subarachnoid hemorrhage (SAH) remain unclear.

Patients and methods

We retrospectively reviewed the medical records of non-traumatic SAH patients aged 80 years or older, who were hospitalized in a single center between 2000 and 2005.

Results

There were 24 patients (80–92 years old and 83% female), representing 8.8% of all non-traumatic SAHs (n = 272). Of those, six patients received an intervention (five clipping and one endovascular coiling) and the remaining 18 patients were managed conservatively. The patients who received an intervention were younger and had a better consciousness at presentation. Early mortality rate within 30 days after SAH was higher in the conservative group (61% [11/18] and 17% [1/6], p = 0.155). At 6 months, mortality rate was significantly higher in the conservative group (83% [15/18] and 33% [2/6], p = 0.038), and independence rate was higher in the intervention group (33% [2/6] and 0% [0/18], p = 0.054). Logistic regression analysis showed that age and degree of consciousness on admission were significant predictor of outcome in 4 weeks, and that receiving intervention was significant predictor of outcome in 6 months.

Conclusion

In elderly SAH patients with good clinical condition at presentation, an active intervention may improve the outcome.

Introduction

In recent years, approximately 5% of the Japanese population has reached 80 years of age and older [1] because of the rapid increase in elderly persons. Elderly stroke patients often have various complications, and the 1-month mortality rate has been reported to approach 50% after a subarachnoid hemorrhage (SAH) [2]. The prognosis for SAH patients 80 years of age and older is thought to be worse than that of patients under 80 years of age because of the higher frequency of complications. One report described 29 SAH patients greater than 80 years of age [3], among whom only five underwent surgery (further details were lacking). Another report suggested the necessity for surgical treatment of SAH patients 80 years of age and older, but data on patients without aneurysmal repair were excluded from the analysis [4].

Since information about the clinical course of SAH patients over 80 years of age is still limited, we require more data in order to improve their treatment. Therefore, we performed a retrospective study of Japanese SAH patients 80 years of age and older.

Section snippets

Patients and methods

The medical records of all patients treated at the International Medical Center of Japan in Tokyo from January 2000 to July 2005 were screened to select SAH patients in their ninth and tenth decades of life. All medical records, including imaging studies, of the patients thus identified were retrospectively reviewed to determine the pre- and post-treatment clinical courses, neurological status, and daily activities. Patients with traumatic SAH was excluded from the clinical course and imaging

Results

A total of 272 patients with SAH were treated during the study period. There were no patients greater than 100 years of age during this period, but there were 24 patients in their 80s and 90s. These 24 patients (8.8% of the total), 20 females and 4 males were studied in detail. Their mean age was 84 ± 3.6 years (range, 80–92 years). The median length of stay at our hospital was 29 days (25th–75th percentile: 4–81 days; range: 2–159 days). The median observation period was 42 days (25th–75th

Discussion

The present findings suggest that elderly SAH patients undergo clipping or endovascular coiling to achieve a better clinical outcome. This implies that we do not have to change our treatment strategy for SAH based on age alone. Although some of the 24 patients may have had non-aneurysmal SAH because some patients did not have the confirmatory test, we determined SAH with their clinical courses and radiologic data (computed tomography, magnetic resonance imaging, magnetic resonance angiography,

Conclusion

The intervention in SAH patients 80 years of age and older was associated with a better long-term outcome and significantly reduced mortality. In elderly SAH patients, an intervention should be considered more actively, particularly newly advancing endovascular therapy.

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