Walk-In Hospital Admission of Patients with Subarachnoid Hemorrhage: Clinical Presentation and Outcome

Abstract

Neurosurgeons occasionally encounter cases of subarachnoid hemorrhage (SAH) in admitted walk-in patients, termed "walk-in SAH." However, their clinical characteristics have not been fully understood. We thus aimed to investigate several characteristics of patients with walk-in SAH and compare them with those of patients with good-grade SAH who arrived at the hospital by ambulance. Between January 2011 and January 2018, consecutive patients with World Federation of Neurosurgical Societies (WFNS) grades I and II aneurysmal SAH were enrolled. They were dichotomized into walk-in and ambulance groups, and their demographic and disease-related characteristics were compared. Furthermore, predictors associated with unfavorable outcomes were investigated in patients with walk-in SAH. Of 171 patients with WFNS grades I and II SAH, 68 (39.8%) were categorized as walk-in SAH. The mean time for diagnosis in patients with walk-in SAH was significantly longer than that in patients who arrived by ambulance (P<0.01). Multivariate analysis demonstrated that a lower rate of hypertension, high grades on the Barrow Neurological Institute scale, and Early Brain Edema Score were significantly associated with walk-in SAH (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.21-0.91, P=0.03; OR 0.32, 95% CI 0.13-0.76, P=0.007; OR 0.11, 95% CI 0.02-0.51, P<0.0001, respectively). Additionally, severe angiographic vasospasm was a significant predictor of unfavorable outcomes in walk-in SAH (OR 37.7, 95% CI 1.10-1290.90, P=0.04). Patients with walk-in SAH exhibit radiological characteristics associated with a more favorable outcome among patients with good-grade SAH. Therefore, these patients may have a positive prognosis.