Study of Factors associated with Neurological Outcome in Traumatic Subarachnoid Hemorrhage

Objective: The goal of this study were to identify the factors that may predict the outcome of subarachnoid hemorrhage (tSAH) patients, and to assist in the management of their treatment. Methods: We retrospectively studied 90 patients admitted to our hospital in the two-year period from January 1, 2003, to December 31, 2004, with an initial computed tomographic (CT) diagnosis of tSAH. Follow-up CT scan changes were reported as "CT change" based on the criteria of the Morris-Marshall classification. The amount of subarachnoid blood was recorded using a modified Fisher classification. Initial neurologic state was assessed at admission with the Glasgow Coma Scale (GCS) and outcome at 6 months after injury with the Glasgow Outcome Scale (GOS). Results: Twenty-seven patients (30%) had an unfavorable GOS outcome. In the univariate analysis, the prognosis was significantly related to GCS score at admission, Morris-Marshall CT classification at admission, Fisher classification and CT change on the worst CT scan. CT change was related to GCS score at admission, Morris-Marshall CT classification, and Fisher classification. From multivariate analysis, the only factors independently related to outcome were the GCS score (p<0.01), combined contusion (p =0.003) and CT change (p<0.001). CT change was related independently to GCS score (p<0.01), combined contusion (p=0.002). Conclusion: It seems that in order to improve the outcomes in tSAH patients, attention will need to be focused on inhibiting contusion growth and on minimizing the effects of tSAH on the brain.