Clinical and Radiological Characteristics of Aneurysmal Subarachnoid Hemorrhage in Older Adults

Abstract

Aim: Clinical status at admission after aneurysmal subarachnoid hemorrhage [aSAH] has been reported to be closely related to age in previous trials. However, there is no data on contemporary registries containing a nationwide unselected population. The Swiss population is characterized by a higher percentage of elderly people. Methods: Patient-related data were extracted from the Swiss SOS database, a nationwide registry uniting Swiss neurovascular centers, covering the years 2009 to 2013. Age, gender, admission scores of aSAH (GCS, WFNS, focal neurological deficits [ND], cranial nerve deficits [CND], Fisher grade), and aneurysm location and size were analyzed. Results: In a series of 1,582 cases of aSAH, mean age at ictus was 55.7 ± 13.24 years. A total of 1,013 (63.3%) subjects were female. Before ictus , 3.1% of patients had an mRS >1. Out of documented 895 cases, 273 (30.5%) and 275 (30.7%) patients were intubated or sedated at admission, respectively. Most patients presented with a GCS 15 (592/1,541; 38.42%), 379 (24.6%) with GSC 13–14, 161 (10.5%) with GCS 7–12, and 409 (26.5%) were comatose (GCS of 3–6). Accordingly, WFNS grade I was recorded in 592/1,538 (38.5%), WFNS II in 276 (18%), WFNS III in 103 (6.7%), WFNS IV and V in 161 (10.47%), and 406 (26.4%). A total of 394 (27%) and 292 (20%) of 1,457 patients presented with either ND or CND. Fisher grades 3 and 4 were more common documented (614/1,359; 45.1% and 560; 41.2%, respectively). Older patients presented with worse GCS (OR 0.989, CI 0.982–0.997, p = 0.006) and a higher likelihood for ND (OR 1.014, 95% CI 1.002–1.027, p = 0.028), which results in a higher WFNS- (OR 1.009, CI 1.001–1.018, p = 0.029). On admission CT, higher Fisher grades (OR 1.011, 95% CI 1.002–1.021, p = 0.017), and thick blood clots (OR 1.002, 95% CI 1.006–1.038, p = 0.006) were more frequently observed. In terms of aneurysm characteristics, anterior location (OR 0.701, p = 0.026, CI 0.514–0.958) and size > 7 mm (OR 1.056, CI 1.027–1.085, p = 0.0001), correlated with presence of a ND, size >7mm as well for CND (OR 1.893, CI 1.302 2.753, p = 0.001). Patients with aneurysms > 7mm were more likely to have a lower GCS (OR 0.682, CI 0.536–0.869, p = 0.002) and higher WFNS (OR 1.554, CI 1.204–2.006, p = 0.001). Conclusion: Older patients admitted with aSAH present more commonly with low GCS, higher WFNS-grades, and were more likely to have ND. In addition, these patients likewise present with more severe Fisher grades on the admission CT.