Delays in the treatment of patients with aneurysmal subarachnoid hemorrhage: Experience at a county hospital

Abstract

Background: Aneurysmal subarachnoid hemorrhage can have devastating consequences, but the early identification of patients with this condition can lead to early intervention to reduce the risks of rebleeding, vasospasm, and increased intracranial pressure. This study examines the characteristics of those patients who had a delay in presentation or transfer to a facility equipped to treat them. Methods: Cases of angiographically documented subarachnoid hemorrhage treated at the Los Angeles County General Hospital were retrospectively reviewed. An interval of 3 or more days between the onset of hemorrhage symptoms and admission to our hospital was defined as delayed. Results: Case records of the most recent 285 patients with 380 aneurysms treated at the Los Angeles County General Hospital were reviewed. One hundred twenty-two patients (42.8%) experienced a delay in admission. Records were available for 86 patients (70.5%). Delays in presentation did not differ by ethnicity. Delays were classified as patient-related (26.7%), delay to obtain an angiogram (19.8%), transportation-related (17.4%), initial misdiagnosis (17.4%), and radiographic misinterpretation (9.3%). Twenty-one patients went to an urgent care or outpatient clinic for treatment, of whom 19 were sent home. Twelve patients made 3 or more visits to a physician before being diagnosed. Eighteen patients suffered a rerupture before admission to our hospital. Nine of these were caused by patient delay, with a rerupture prompting an emergency visit, and 4 reruptures were the result of a radiographic misdiagnosis. Conclusions: Delays in the diagnosis and treatment of aneurysmal subarachnoid hemorrhage are frequent. Increased public awareness of the signs of a “Brain Attack,” as well as improved physician education about subarachnoid hemorrhage should reduce delays in consultation and referral.