In Some Brain Bleeds, Patients Do Better at High-Volume Hospitals

Guidelines for treating 'aneurysmal subarachnoid hemorrhage' revised

By Mary Elizabeth Dallas

Thursday, May 3, 2012

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THURSDAY, May 3 (HealthDay News) -- People diagnosed in the emergency room with a specific type of bleeding stroke should immediately be transferred to a hospital that treats at least 35 of these cases each year, according to new recommendations from the American Heart Association and the American Stroke Association.
Aneurysmal subarachnoid hemorrhage occurs when a weakened blood vessel within the brain ruptures, resulting in bleeding into the space around the brain.
Death rates within a month after this type of stroke were 39 percent in hospitals admitting fewer than 10 such patients each year, compared with 27 percent in hospitals treating more than 35 of these patients, according to an association news release.
"Admission to high-volume centers has been associated with lower disability and death," said Dr. E. Sander Connolly Jr., chairman of the statement-writing group, said in the release. "While the reasons for this association are not completely clear, patients admitted to high-volume facilities have increased access to experienced cerebrovascular surgeons and endovascular specialists, as well as multidisciplinary neuro intensive-care services."
Although prevention recommendations still focus on controlling high blood pressure, avoiding cigarettes and excessive drinking, the association provided additional treatment recommendations, updating guidelines from 2009.
Among the recommendations:

Blood pressure should be controlled to balance the risk of stroke and hypertension-related re-bleeding.
Follow-up imaging after surgical treatment of an aneurysm should be delayed unless there is a reason it's needed sooner.

The guidelines also cautioned people to take immediate action if certain symptoms appear, including:

A severe headache that develops suddenly
Vomiting
Confusion
Loss of consciousness
Seizures

"Most people do not recognize when [a brain bleed] is occurring, and anyone who experiences the 'worst headache of your life,' should get to the closest ER immediately," warned Connolly, who is the vice chairman of neurological surgery at Columbia University in New York City and co-director of the neurosciences intensive-care unit at New York-Presbyterian Hospital.
The updated guidelines appear online Thursday in the journal Stroke.

SOURCE: American Heart Association and American Stroke Association, news release, April 30, 2012

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