Evidence map›Paper›PMID 34422101›Full record

ArticleJournal of the Intensive Care Society2021

Outcomes following acute poor-grade aneurysmal subarachnoid bleed - Is early definitive treatment better than delayed management?

Adam Gittins, Nick Talbott, Ahmed A Gilani, Greg Packer, Richard Browne, Randeep Mullhi, Zaheed Khan, T Whitehouse, Antonio Belli, Rajnikant L Mehta and 2 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the Intensive Care Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Outcome of Cerebral Aneurysm Clipping in Nigeria: A Single-Centre Experience.Nigerian medical journal : journal of the Nigeria Medical Association
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Adam GittinsDivision of Anaesthesia and Critical Care, University of Birmingham, Birmingham, UK.
Nick TalbottDivision of Anaesthesia and Critical Care, University of Birmingham, Birmingham, UK.
Ahmed A GilaniDivision of Anaesthesia and Critical Care, University of Birmingham, Birmingham, UK.
Greg PackerDivision of Anaesthesia and Critical Care, University of Birmingham, Birmingham, UK.
Richard BrowneDivision of Anaesthesia and Critical Care, University of Birmingham, Birmingham, UK.
Randeep MullhiDivision of Anaesthesia and Critical Care, University of Birmingham, Birmingham, UK.
Zaheed KhanDivision of Anaesthesia and Critical Care, University of Birmingham, Birmingham, UK.
T WhitehouseDivision of Anaesthesia and Critical Care, University of Birmingham, Birmingham, UK.ORCID https://orcid.org/0000-0002-4387-3421
Antonio BelliDepartment of Neurosurgery, University of Birmingham, Birmingham, UK.
Rajnikant L MehtaBirmingham Acute Care Research Group, Division of Anaesthesia and Critical Care, University of Birmingham, Birmingham, UK.
Fang Gao-SmithBirmingham Acute Care Research Group, Division of Anaesthesia and Critical Care, University of Birmingham, Birmingham, UK.
Tonny VeenithBirmingham Acute Care Research Group, Division of Anaesthesia and Critical Care, University of Birmingham, Birmingham, UK.ORCID https://orcid.org/0000-0002-4125-8804

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND/

objectivePatients with poor-grade subarachnoid bleed (World Federation of Neurosurgical Societies grades 4-5) often improve their neurocognitive function months after their ictus. However, it is essential to explore the timing of intervention and its impact on long-term outcome. We compared the long-term outcomes between immediate management within 24 h and delayed management after 24 h in patients following poor-grade subarachnoid bleed.

methodsThis was a retrospective population-based study, including patients with poor-grade subarachnoid bleed who received definitive management between 1 January 2011 and 31 December 2016 in a large tertiary neurocritical care unit. The primary outcome was adjusted odds ratio of favourable outcome (Glasgow Outcome Scale 4-5) for survivors at 12 months following discharge, as measured by the Glasgow Outcome Scale. The secondary outcomes included adjusted odds ratio of a favourable outcome at discharge, 3 months and 6 months following discharge and survival rate at 28 days, 3 months, 6 months and 12 months following haemorrhage.

resultsA total of 111 patients were included in this study: 53 (48%) received immediate management and 58 (52%) received delayed management. The mean time delay from referral to intervention was 14.9 ± 5.8 h in immediate management patients, compared to 79.6 ± 106.1 h in delayed management patients. At 12 months following discharge, the adjusted odds ratio for favourable outcome in immediate management versus delayed management patients was 0.96 (confidence interval (CI) = 0.17, 5.39;

conclusionsImmediate management and delayed management after poor-grade subarachnoid bleed are associated with similar morbidity and mortality at 12 months. Therefore, delaying intervention in poor-grade patients may be a reasonable approach, especially if time is needed to plan the procedure or stabilise the patient adequately.

Indexed as

aneurysmcritical careneuroimagingneurosurgerystrokeSubarachnoid haemorrhage

Identifiers

PMID34422101
PMCPMC8373283

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.