Time intervals from aneurysmal subarachnoid hemorrhage to treatment and factors contributing to delay
Time intervals from aneurysmal subarachnoid hemorrhage to treatment and factors contributing to delay
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DOI：
10.1007/s00415-013-7218-2
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发表时间：
2014-03-01
影响因子：
6
通讯作者：
Verbaan, Dagmar
中科院分区：
文献类型：
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作者：
Germans, Menno R.;Hoogmoed, Jantien;Verbaan, Dagmar
在动脉瘤性蛛网膜下腔出血（aSAH）的管理中，必须尽早进行动脉瘤治疗，以最大限度地降低再出血的风险，从而改善结局。我们评估了从aSAH首次症状到开始动脉瘤治疗的不同时间间隔，以确定哪些因素主要导致治疗时间延迟。在278例aSAH患者中，回顾性分析了从初始出血到动脉瘤治疗的不同步骤之间的时间间隔，并确定了延迟因素。半数患者在115分钟内到医院就诊（IQR 60-431）。从出血到诊断的中位（IQR）时间间隔为169 min（96-513），从诊断到治疗的中位（IQR）时间间隔为1，057 min（416- 1，428）或17.6 h。76%的治疗患者在24小时内开始动脉瘤治疗。预测治疗延迟的独立因素是在转诊医院的主要表现和当天晚些时候进入治疗中心。治疗延迟与不良结局并不独立相关。根据在缺血性卒中治疗中成功采用的“时间就是大脑”概念，通过立即直接运送到治疗中心并优化院内物流，可以改善动脉瘤治疗的间隔。
In the management of aneurysmal subarachnoid hemorrhage (aSAH), aneurysm treatment as early as feasible is mandatory to minimize the risk of a rebleed and may thus improve outcome. We assessed the different time intervals from the first symptoms of aSAH to start of aneurysm treatment in an effort to identify which factors contribute mostly to a delay in time to treatment. In 278 aSAH patients, time intervals between the different steps from initial hemorrhage to aneurysm treatment were retrospectively reviewed, and delaying factors were determined. Half of the patients presented to a hospital within 115 min (IQR 60-431). The median (IQR) interval from hemorrhage to diagnosis was 169 min (96-513), and from diagnosis to treatment 1,057 min (416-1,428), or 17.6 h. Aneurysm treatment started within 24 h in 76 % of treated patients. Independent factors predicting delay to treatment were primary presentation at a referring hospital and admission to the treatment center later in the day. Delay in treatment was not independently related to poor outcome. The interval to aneurysm treatment might be improved upon by immediate and direct transport to the treatment center combined with optimization of in-hospital logistics, following the 'time-is-brain' concept so successfully adopted in the treatment of ischemic stroke.