ArticleNeurocritical care2023
Clinical Characteristics and Outcomes of Patients with Aneurysmal Subarachnoid Hemorrhage: A Prospective Multicenter Study in a Middle-Income Country.
Article in Neurocritical care, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Timing of aneurysm repair and clinical outcomes after aneurysmal subarachnoid hemorrhage: a systematic review.Journal of neurology · 2026Pooled it
- Bridging Continents, Closing Gaps: A Multicenter Cohort Study on Subarachnoid Hemorrhage Outcomes and Health Care Disparities.Neurocritical care · 2026Article
- Prediction of recurrence and functional status in young ischemic stroke patients: Comparison of machine learning and traditional statistical methods.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Article
- Geographical accessibility and case loads in subarachnoid hemorrhage care: a nationwide study of German hospitals.Neurosurgical review · 2025Observational
- Neurocritical Care Organization in the Low-Income and Middle-Income Countries.Neurocritical care · 2025Article
- Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: a narrative review.Arquivos de neuro-psiquiatria · 2025Review
- Nationwide epidemiological study of subarachnoid hemorrhage: trends in admissions, mortality, seasonality, costs, clipping, embolization, and the impact of COVID-19.Frontiers in neurology · 2025Article
- Clip versus coil shift for aneurysm treatment in Brazil: an exploratory analysis of trends in a 10-year time-series.Neurosurgical review · 2024Review
- Clinical Characteristics and Outcome of Patients With Intraoperative Aneurysm Rupture: A Retrospective Cohort Study From Nepal.Neurosurgery practice · 2024Article
- Lower respiratory tract infections due to multi‑drug resistant pathogens in central nervous system injuries (Review).Biomedical reports · 2023Review
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Authors and funding
14 authors.
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Abstract
backgroundAneurysmal subarachnoid hemorrhage (SAH) is associated with high mortality and long-term functional impairment. Data on clinical management and functional outcomes from developing countries are scarce. We aimed to define patient profiles and clinical practices and evaluate long-term outcomes after SAH in a middle-income country.
methodsThis was a prospective study including consecutive adult patients admitted with SAH to two reference centers in Brazil from January 2016 to February 2020. The primary outcome was functional status at 6 months using the modified Rankin Scale. Mixed multivariable analysis was performed to determine the relationship between clinical variables and functional outcomes.
resultsFrom 471patients analyzed, the median time from symptom onset to arrival at a study center was 4 days (interquartile range 0-9). Median age was 55 years (interquartile range 46-62) and 353 (75%) patients were women. A total of 426 patients (90%) were transferred from nonspecialized general hospitals, initial computed tomography revealed thick hemorrhage in 73% of patients (modified Fisher score of 3 or 4), and 136 (29%) had poor clinical grade (World Federation of Neurological Surgeons score of 4 or 5). A total of 312 (66%) patients underwent surgical clipping, and 119 (25%) underwent endovascular coiling. Only 34 patients (7%) underwent withdrawal or withholding of life-sustaining therapy during their hospital stay, and in-hospital mortality was 24%. A total of 187 (40%) patients had an unfavorable long-term functional outcome (modified Rankin Scale score of 4 to 6). Factors associated with unfavorable outcome were age (adjusted odds ratio [OR] 1.05, 95% confidence interval [CI] 1.03-1.08), hypertension (adjusted OR 1.81, 95% CI 1.04-3.16), poor clinical grade (adjusted OR 4.92, 95% CI 2.85-8.48), external ventricular drain (adjusted OR 3.8, 95% CI 2.31-6.24), postoperative deterioration (adjusted OR 2.33, 95% CI 1.32-4.13), cerebral infarction (adjusted OR 3.16, 95% CI 1.81-5.52), rebleeding (adjusted OR 2.95, 95% CI 1.13-7.69), and sepsis (adjusted OR 2.68, 95% CI 1.42-5.05).
conclusionsOur study demonstrated that SAH management in a middle-income country diverges significantly from published cohorts and current guidelines, despite comparable clinical profiles on presentation and admission to high-volume referral centers. Earlier aneurysm occlusion and increased use of endovascular therapy could potentially reduce modifiable in-hospital complications and improve functional outcomes in Brazil.
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