Time and predictors of time to treatment for aneurysmal subarachnoid haemorrhage (aSAH): a systematic review

Abstract Background Aneurysmal subarachnoid haemorrhage (aSAH) is a serious form of stroke, for which rapid access to specialist neurocritical care associated with better outcomes. Delays in the treatment aSAH appear be common and may contribute poor We have limited understanding extent causes these delays, hinders development interventions reduce delays improve The aim this systematic review was quantify identify factors time aSAH. Methods This performed according Preferred Reporting Items Systematic Review Meta-Analysis guidelines registered PROSPERO (Reg. No. CRD42019132748). searched four electronic databases (MEDLINE, EMBASE, Web Science Google Scholar) manuscripts published from January 1998 using pre-designated search terms strategy. Main outcomes were duration intervals onset definitive and/or related treatment. Results A total 64 studies 16 different pathway patients identified. Measures varied between (e.g. cut-off timepoints or absolute mean/median duration). Factors fell into two categories—individual (n = 9 factors, e.g. age, sex clinical characteristics) health system 8 pre-hospital delay presentation out-of-hours). Demographic not More severe reduced most studies. Pre-hospital (patients delay, late referral, arrival ambulance, being transferred hospitals arriving at hospital outside office hours) delay. In-hospital complications, procedure before treatment, slow work-up type treatment) less Conclusions consists multiple stages influencing factors. provides first comprehensive There an opportunity target modifiable but further research considering more are needed.