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Warning headache correlates survival rate in aneurysmal subarachnoid hemorrhage

Authors :
Pei-Kwei Tsay
Ching-Chang Chen
Alvin Yi-Chou Wang
Chi-Hung Liu
Chuan-Min Lin
Yi-Ming Wu
Chien-Hung Chang
Source :
Biomedical Journal, Biomedical Journal, Vol 42, Iss 5, Pp 352-357 (2019)
Publication Year :
2019
Publisher :
Elsevier BV, 2019.

Abstract

Background: Severe headaches, projectile vomiting, focal neurological deficits and early onset seizure are regarded as early warning symptoms of subarachnoid hemorrhage (SAH). Earlier diagnosis based on such warning symptoms theoretically would improve the clinical prognosis. However, it is still not clear whether the prognosis is correlated with early warning symptoms. Here, we reviewed warning symptoms and other predictive factors in the emergency room (ER) setting and examined their correlations with mortality. Methods: Ninety saccular aneurysmal SAH cases were reviewed in a single medical center between January 2011 and December 2013. We examined differences in mortality rate related to warning symptoms, SAH scales, onset-to-ER time, hydrocephalus, and aneurysm size, location, and complexity. Logistic regression analyses were performed to determine the correlations of warning symptoms and other predictive factors with mortality. Receiver operating characteristic (ROC) curve analysis was used to calculate the area the under curve (AUC) of SAH mortality prediction tools. Results: Warning headache, projectile vomiting, the Hunt and Hess scale, Fisher scale, World Federation of Neurological Surgeons (WFNS) grading scale, and modified WFNS (m-WFNS) scale, body mass index, aneurysm complexity and hydrocephalus were significantly different between the survivors and the decedents. The warning headache and WFNS grade were strongly correlated with mortality. The rate of prognostic prediction improved from 90.4% to 94.6% when warning headache was additionally evaluated. Conclusions: With growing healthcare costs and recognition of the value of palliative care, early identification via warning headache and a detailed clinical history review is necessary for cases of aSAH. Keywords: Warning headache, SAH, WFNS, Survival rate

Details

ISSN :
23194170
Volume :
42
Database :
OpenAIRE
Journal :
Biomedical Journal
Accession number :
edsair.doi.dedup.....4ffc301874617a86a727c82c6775fcfd
Full Text :
https://doi.org/10.1016/j.bj.2019.04.006