Outcomes in a Case Series of Elderly Patients with Aneurysmal Subarachnoid Hemorrhages in the Barrow Ruptured Aneurysm Trial (BRAT)

Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) is debilitating in elderly patients, but literature regarding this population is scarce, and clinical decision-making remains debated. Outcomes of elderly patients with aSAH stratified by age and clinical presentation were analyzed. Patients treated for aSAH were retrospectively analyzed. Patients were trichotomized into a young cohort (aged <60 years [n= 268]) and 2 elderly cohorts (aged 60-65 years [n= 60] and ≥65 years [n= 77]). The elderly cohorts were analyzed by poor or good scores at presentation (Hunt and Hess [HH] score >3 vs. ≤3, respectively) and poor functional outcome (modified Rankin Scale score >2). Of 137 elderly patients, 121 had a 6-year follow-up. The >65-year-olds (75% [52/69]) were more likely to have poor functional outcomes than the 60 to 65-year-olds (48% [25/52]) (odds ratio, 3.3; 95% confidence interval, 1.5-7.1; P= 0.002). Among those with an HH score ≤3 at presentation (n= 90), the >65-year-old cohort had poorer outcomes than the 60 to 65-year-old cohort at 6-year follow-up (69% [35/51] vs. 36% [14/39], respectively; odds ratio, 3.9; 95% confidence interval, 1.6-9.4; P= 0.003). Among patients with an HH score >3, no statistically significant differences in functional outcome were observed between the >65-year-old (n= 18) and 60 to 65-year-old (n= 13) cohorts. Elderly patients with aSAH are at high risk for poor functional outcomes. However, among those presenting with good HH scores, younger-elderly patients (aged 60-65 years) tend to fare better than older-elderly patients (aged >65 years). Elderly patients presenting with high-grade aSAH fare poorly regardless of age, which can inform clinical decision-making and prognostication.