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The path from ictus to Neurosurgery: chronology and transport logistics of patients with aneurysmal subarachnoid haemorrhage in the South-Eastern Norway Health Region

  • Original Article - Vascular Neurosurgery - Aneurysm
  • Published:
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Abstract

Background

Guidelines state that patients with aneurysmal subarachnoid haemorrhage (aSAH) require neurosurgical treatment as early as possible. Little is known about the time frame of transport from the ictus scene to Neurosurgery in large, partially remote catchment areas. We therefore analysed the chronology and transport logistics of aSAH patients in the South-Eastern Norway Health Region and related them to the frequency of aneurysm rebleed and 1-year mortality.

Methods

Retrospective analysis of aSAH patients bleeding within our region admitted to Neurosurgery during a 5-year period. Date, time and site of ictus and arrival at Neurosurgery, distance and mode of transport and admission were obtained from our institutional quality register and the emergency medical communication centre log. We scored the patients’ clinical condition, rebleeds and 1-year mortality.

Results

Five hundred forty-four patients were included. Median time from ictus to arrival Neurosurgery was 4.5 h. Transport by road ambulance was most common at distances between the ictus scene and Neurosurgery below 50 km, whereas airborne transport became increasingly more common at larger distances. Direct admissions, frequency of intubation and airborne transport to Neurosurgery increased with the severity of haemorrhage, leading to shorter transport times. The risk of rebleed was 0.8%/hour of transport. The rebleed rate was independent of distances travelled, but increased with the severity of aSAH, reaching up to 6.54%/hour in poor-grade patients. Distance and time of transport had no impact on 1-year mortality, whereas poor-grade aSAH and rebleed were strong predictors of mortality.

Conclusions

Poor-grade aSAH patients have a high risk of rebleed independent of the distance between the ictus scene and Neurosurgery. As rebleeding triples 1-year mortality, patients with Glasgow Coma Score < 9 with suspected aSAH should be admitted directly to Neurosurgery without delay after best possible cardiovascular and airway optimisation on site by competent personnel.

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Abbreviations

aSAH:

Aneurysmal subarachnoid haemorrhage

CI:

Confidence interval

CT:

Computed tomography

CTA:

Computed tomography angiography

GCS:

Glasgow Coma Scale

HEMS:

Helicopter Emergency Medical Services

OR:

Odds ratio

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Authors and Affiliations

  1. Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, P.B. 0454, Nydalen, 0424, Oslo, Norway

    Angelika Sorteberg & Wilhelm Sorteberg

  2. Institute of Clinical Medicine, University of Oslo, P.B. 1072, Blindern, 0316, Oslo, Norway

    Angelika Sorteberg

  3. Prehospital Division, Air Ambulance Department, Oslo University Hospital, P.B. 0454, Nydalen, 0424, Oslo, Norway

    Per Poelhøi Bredmose & Andreas Ernst Hansen

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  1. Angelika Sorteberg
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  2. Per Poelhøi Bredmose
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  3. Andreas Ernst Hansen
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  4. Wilhelm Sorteberg
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Correspondence to Angelika Sorteberg.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. Data retrieval has been approved by the institutional data protection officer.

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This article is part of the Topical Collection on Vascular Neurosurgery - Aneurysm

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Sorteberg, A., Bredmose, P.P., Hansen, A.E. et al. The path from ictus to Neurosurgery: chronology and transport logistics of patients with aneurysmal subarachnoid haemorrhage in the South-Eastern Norway Health Region. Acta Neurochir 161, 1497–1506 (2019). https://doi.org/10.1007/s00701-019-03971-9

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  • DOI: https://doi.org/10.1007/s00701-019-03971-9

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