Hosokawa Yuma, Fukuda Hitoshi, Hyohdoh Yuki, Kawamura Takako, Shinno Ken, Yanase Yongran, Yokodani Masaki, Hoashi Yu, Moriki Akihito, Bando Koji, Matsushita Nobuhisa, Hamada Fumihiro, Kawanishi Yu, Ueba Yusuke, Fukui Naoki, Masahira Noritaka, Nishimoto Yo, Ueba Tetsuya
Department of Neurosurgery, Kochi Medical School, Kochi University, Nankoku 783-8505, Japan.
Center of Medical Information Science, Kochi University, Kochi 783-8505, Japan.
J Clin Med. 2025 May 18;14(10):3537. doi: 10.3390/jcm14103537.
: Aneurysmal subarachnoid hemorrhage (SAH) requires prompt treatment, yet hospital admission is occasionally delayed, and the optimal treatment strategy for such patients remains to be established. We aimed to investigate treatment modality, treatment timing, and outcomes in patients with SAH with respect to early versus delayed admission. : A total of 1080 patients with SAH and a defined onset date were included in this prefecture-wide, multicenter, registry-based study. Baseline characteristics, late SAH complications (including vasospasm), and functional outcomes were compared between early and delayed admission groups at Day 4 or later (Day 0 = SAH onset). Additionally, the association of treatment choice (endovascular therapy or direct surgery) with treatment timing was analyzed in the delayed admission group. : Delayed admission was observed in 69 (6.4%) patients. The neurological status upon admission was significantly better in the delayed admission group, with more World Federation of Neurological Societies grades I-II (89.8% vs. 56.2% in the early admission group). Delayed admission was significantly associated with an increased incidence of symptomatic vasospasm by multivariable logistic regression analysis (odds ratio 2.51: 95% confidence interval 1.26-5.00, = 0.009), while a significant difference in poor functional outcomes (modified Rankin scale 3-6) was not revealed. Although endovascular therapy use did not increase in the delayed admission group, the interval from admission to endovascular therapy was significantly shorter than that in the direct surgery group (0 [0-1] days vs. 1 [1-8] days: median [interquartile range], = 0.007, Mann-Whitney U test). : Delayed admission was a risk factor for symptomatic vasospasm; however, functional outcomes were not exacerbated. These results were obtained under the treatment strategy of multiple institutions, where the timing of endovascular therapy was earlier than that of direct surgery in patients with delayed admission.
动脉瘤性蛛网膜下腔出血（SAH）需要及时治疗，但有时会延迟入院，此类患者的最佳治疗策略仍有待确定。我们旨在研究SAH患者早期与延迟入院的治疗方式、治疗时机及预后。
本全州范围、多中心、基于登记的研究纳入了1080例有明确发病日期的SAH患者。比较了早期和延迟入院组在第4天或之后（第0天=SAH发病）的基线特征、SAH晚期并发症（包括血管痉挛）及功能预后。此外，在延迟入院组分析了治疗选择（血管内治疗或直接手术）与治疗时机的关联。
69例（6.4%）患者出现延迟入院。延迟入院组入院时的神经状态明显更好，世界神经外科联合会分级为I-II级的患者更多（89.8% vs. 早期入院组的56.2%）。多变量逻辑回归分析显示延迟入院与症状性血管痉挛发生率增加显著相关（比值比2.51：95%置信区间1.26 - 5.00，P = 0.009），而在功能预后不良（改良Rankin量表3 - 6级）方面未发现显著差异。虽然延迟入院组血管内治疗的使用未增加，但从入院到血管内治疗的间隔明显短于直接手术组（0[0 - 1]天 vs. 1[1 - 8]天：中位数[四分位间距]，P = 0.007，Mann-Whitney U检验）。
延迟入院是症状性血管痉挛的危险因素；然而，功能预后并未恶化。这些结果是在多机构治疗策略下获得的，其中延迟入院患者的血管内治疗时机早于直接手术。
