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Título

EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS OF ANEURYSMAL SUBARACHNOID HEMORRHAGE PATIENTS IN A BRAZILIAN TERTIARY NEUROINTENSIVE CRITICAL CARE UNIT

Resumo

INTRODUCTION: Subarachnoid hemorrhage (SAH) is a rare and life-threatening cerebrovascular disease. Ruptured aneurysms are the most common cause of atraumatic SAH. It is one of the main medical emergencies associated with high rates of morbidity and mortality and years lived with disability. In Brazil epidemiology of aneurysmal SAH remains unknown.
OBJECTIVES: To evaluate epidemiological and clinical data and outcomes such as mortality, time of mechanical ventilation of aneurysmal subarachnoid hemorrhage patients interned in a tertiary neurointensive critical care unit.
METHODS: This is a cross-sectional study. Patients with SAH admitted to the neurointensive critical care unit (neuroICU) in a tertiary care public hospital were eligible. The inclusion criteria were a minimum stay in the intensive care unit (ICU) of 24 h, due to subarachnoid hemorrhage from a nontraumatic spontaneously ruptured cerebral aneurysm, and hospital admission within 24 h after the onset of symptoms.
RESULTS: Our population was mainly composed by women (67.2%). The most reported symptoms were syncope (26%), isolated headache (23.2%), headache and syncope (16.3%). Twenty-eight percent presented Hunt Hess Scale grade II and 62.1% presented Fisher scale grade 4. Sixty-eight percent required mechanical ventilation, 48.6% presented vasospasm, 5.1% presented rebleeding, 36.7% acute hypertensive hydrocephalus, 40.7% died. Females presented higher mean of age than males (women: 57.21±12.20 years; men: 51.34±12.54 years; p=0.03) and also had the longest waiting time for an intensive care unit bed (women: 6.12±6.71 days; 4.21±3.56 days; p=0.01). When stratified by sex there was no statistical significance among outcomes such as rebleeding, vasospasm, delayed cerebral ischemia, acute hypertensive hydrocephalus, death. When stratified by type of discharge, death was statistically associated with vasospasm (OR 2.138 p=0.01) and acute hypertensive hydrocephalus (OR 2.136 p=0.01).
CONCLUSIONS: This study can address relevant data about epidemiological and clinical factors involving subarachnoid hemorrhage patients. As reported in literature the majority of patients were female. Percentages of complications are similar from the previous reported. It is noteworthy that women spent more time waiting for a specialized bed.

Palavras Chave

Hemorragia Subaracnoidea; Aneurisma; Unidades de Cuidados Intensivos; Desfechos; Mortalidade.