ArticleNeurocritical care2026
Timing of Treatment and Long-Term Outcomes in Poor-Grade Aneurysmal Subarachnoid Hemorrhage: A Multicenter Analysis.
Article in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.
What it found
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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.
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.
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Who cites it
1 citing paper 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
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
backgroundPoor-grade aneurysmal subarachnoid hemorrhage (aSAH), defined as World Federation of Neurosurgical Societies (WFNS) grades IV-V on admission, is associated with high mortality and disability. Although treatment initiation within 72 h is commonly recommended, the differential efficacy of specific subintervals during this therapeutic window (e.g., < 12 h, 12-24 h, and 24-72 h) has not been established. This study aims to determine the optimal timing of treatment of poor-grade aSAH using a large multicenter cohort.
methodsThis cohort study included 990 cases of poor-grade (defined as WFNS grades IV-V on admission) aSAH identified retrospectively across 12 centers. Patients were classified into three different treatment time windows: < 12 h (n = 320), 12-23 h (n = 220), and ≥ 24 h (n = 450) after symptom onset. Outcomes included mortality, unfavorable outcome (modified Rankin scale [mRS] scores 3-6), and dependency (mRS scores 3-5) at follow-up. Cox proportional hazards regression models and competing risk analyses were used to assess the association between treatment delay and outcomes.
resultsDuring a median follow-up of 34.3 months, mortality rates were 46.6% for < 12 h, 38.2% for 12-23 h, and 32.4% for ≥ 24 h. Cox regression analysis revealed that treatment delays of 12-23 h (adjusted hazard ratio 0.73, 95% confidence interval 0.55-0.95) and ≥ 24 h (adjusted hazard ratio 0.64, 95% confidence interval 0.51-0.81) were associated with lower all-cause mortality compared to treatment within 12 h. Additionally, treatment delay of ≥ 24 h was associated with lower aSAH-related mortality (adjusted hazard ratio 0.62, 95% confidence interval 0.47-0.81). No significant association was found for aSAH-unrelated mortality. These findings were consistent across various patient characteristics in subgroup analyses.
conclusionsOur findings indicate that treatment delay of less than 12 h after symptom onset was associated with increased mortality risk and exacerbated long-term clinical outcomes in patients with poor-grade aSAH in contemporary practice. However, the lack of control groups limits the generalizability of these data to clinical practice. Future prospective studies are warranted to confirm these results.
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