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Association of onset-to-treatment time with mortality from aneurysmal subarachnoid hemorrhage

  • Annisa Amalina ,
  • Abrar Arham ,
  • Beny Rilianto ,
  • Bambang Tri Prasetyo ,
  • Ricky G Kurniawan ,
  • Muhammad Kusdiansah ,

Abstract

Background: The timing of neurosurgical and/or endovascular intervention for aneurysmal subarachnoid hemorrhage (aSAH) has been associated with the improvement of patient outcomes. However, there is still lack of evidence, also with a significant risk of bias from subjective stratifications such as timing, limited to one center, or treatment modality. This study aimed to examine the association between the onset-to-treatment time and in-hospital mortality in patients with aSAH.

Methods: We retrospectively reviewed the in-hospital records of aSAH patients admitted between January 2019 to December 2022 from the Stroke Registry in the National Brain Center Hospital, East Jakarta, Indonesia. Patients with aSAH derived from digital subtraction angiography (DSA) / computed tomography angiography (CTA) examination were analyzed for onset-to-treatment time to patient mortality. Statistical analyses were carried out with STATA 17.0. The p-value of < 0.25 was considered significant between groups.

Results: A total of 100 subjects who received endovascular coiling or neurosurgical clipping were studied and divided into two groups (dead and alive). The average age was 55.7 ± 11.3 and was dominated by females (64 subjects). In bivariate analysis, onset-to-treatment had significant differences between groups (OR 0.43 [95% CI 0.07-1.73]; p = 0.20) along with gender, SAH grading, location, hypertension, and dyslipidemia. However, in multivariate analysis, there was no association found between onset-to-treatment with in-hospital mortality (p = 0.41), while the grade of SAH had the greatest influence on hospital mortality (aOR 3.90 (95% CI 1.14-13.28); p = 0.029).

Conclusion: This study found no association between onset-to-treatment over three days with in-hospital mortality. Instead, the grade of SAH had the greatest influence on hospital mortality.

Keywords: aneurysmal subarachnoid hemorrhage, clipping, coiling, onset-to-treatment

How to Cite

Amalina, A., Arham, A., Rilianto, B., Prasetyo, B. T., Kurniawan, R. G., & Kusdiansah, M. (2024). Association of onset-to-treatment time with mortality from aneurysmal subarachnoid hemorrhage. Indonesian Journal of Neurosurgery, 7(1), 42–45. https://doi.org/10.15562/ijn.v7i1.280

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