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Clinical Outcome of Patients with Poor-Grade Aneurysmal Subarachnoid Hemorrhage with Bundled Treatments: A Propensity Score-Matched Analysis

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The Original Article was published on 23 August 2023

Abstract

Background

Poor-grade aneurysmal subarachnoid hemorrhage (aSAH), defined as Hunt and Hess (HH) grades IV and V, is a challenging disease because of its high mortality and poor functional outcomes. The effectiveness of bundled treatments has been demonstrated in critical diseases. Therefore, poor-grade aSAH bundled treatments have been established. This study aims to evaluate whether bundled treatments can improve long-term outcomes and mortality in patients with poor-grade aSAH.

Methods

This is a comparative study using historical control from 2008 to 2022. Bundled treatments were introduced in 2017. We compared the rate of favorable outcomes (modified Rankin Scale score 0–2) at 6 months and mortality before and after the introduction of the bundled treatments. To eliminate confounding bias, the propensity score matching method was used.

Results

A total of 90 consecutive patients were evaluated. Forty-three patients received bundled treatments, and 47 patients received conventional care. The proportion of patients with HH grade V was higher in the bundle treatment group (41.9% vs. 27.7%). Conversely, the proportion of patients with fixed pupils on the initial examination was higher in the conventional group (30.2% vs. 38.3%). After 1:1 propensity score matching, 31 pairs were allocated to each group. The proportion of patients with 6-month favorable functional outcomes was significantly higher in the bundled treatments group (46.4% vs. 20.7%, p = 0.04). The 6-month mortality rate was 14.3% in the bundled treatments group and 27.3% in the conventional group (p = 0.01). Bundled treatments (odd ratio 14.6 [95% confidence interval 2.1–100.0], p < 0.01) and the presence of an initial pupil reflex (odd ratio 12.0 [95% confidence interval 1.4–104.6], p = 0.02) were significantly associated with a 6-month favorable functional outcome.

Conclusions

The bundled treatments improve 6-month functional outcome and mortality in patients with poor-grade aSAH.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea

    Young Hoon Choi

  2. Department of Critical Care Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea

    Eun Jin Ha, Youngbo Shim & Jungook Kim

  3. Department of Neurosurgery, College of Medicine, Seoul National University, Seoul, Republic of Korea

    Eun Jin Ha, Sung Ho Lee, Kang Min Kim, Won-Sang Cho, Hyun-Seung Kang & Jeoug Eun Kim

  4. Department of Neurosurgery, Seoul St. Mary’s Hospital and College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Yoon-Hee Choo

  5. Department of Neurosurgery, Incheon St. Mary’s Hospital and College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea

    Hye Seon Kim

  6. Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea

    Sung Ho Lee, Kang Min Kim, Won-Sang Cho, Hyun-Seung Kang & Jeoug Eun Kim

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Contributions

Conceptualization: EJH. Formal analysis: YHC. Investigation: YS, JK, Y-HC, HSK, SHL, KmK, W-SC, H-SK, JEK. Writing (original draft): YHC. Writing (review and editing): EJH. All authors approved the final version of the manuscript before submission.

Corresponding author

Correspondence to Eun Jin Ha.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval/Informed Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The institutional review board of our institute approved this study (No. 2302-045-1402). Informed consent was waived for the retrospectively studied participants because our study did not adversely affect their rights and welfare. Participants or the legal guardians of participants in the newly developed bundle protocol group provided written informed consent prior to study enrollment.

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Choi, Y.H., Ha, E.J., Shim, Y. et al. Clinical Outcome of Patients with Poor-Grade Aneurysmal Subarachnoid Hemorrhage with Bundled Treatments: A Propensity Score-Matched Analysis. Neurocrit Care 40, 177–186 (2024). https://doi.org/10.1007/s12028-023-01818-x

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