Delayed referral of patients with aneurysmal subarachnoid haemorrhage

OBJECTIVE To determine the outcome of patients with subarachnoid haemorrhage and whether delays in their diagnosis and referral have been reduced over a 15-year period. DESIGN A 15-year retrospective study of patients admitted to a tertiary neurosurgical unit between 1977 and 1992. SETTING The Royal North Shore Hospital, Sydney. PATIENTS 511 patients admitted with subarachnoid haemorrhage from ruptured intracranial aneurysms. RESULTS Of 486 patients with at least a six-month follow-up, 66% made a good recovery and 19% died. Outcome was significantly influenced by the neurological condition of the patient at admission (P < 0.0001). There was no significant difference in the relative proportions of patients transferred late (three or more days after onset of symptoms) when those admitted before and after 1986 were compared. CONCLUSION Delayed diagnosis and referral remain the major preventable problems in the management of patients with aneurysmal subarachnoid haemorrhage.