LEVEL OF CONSCIOUSNESS AND AGE AS PROGNOSTIC FACTORS IN ANEURYSMAL SAH

The prognostic value of the level of consciousness and the patient' s age for the outcome of aneurysmal subarachnoid haemorrhage (SAH) is studied in 74 patients admitted on day (D) 0 to D 3 after aneurysm rupture. For the level of consciousness three groups of patients are compared: grade I + II (alert patients), grade III + IV (drowsy patients), and grade V (comatose patients). For the age, two groups are compared: patients aged under 50, and patients aged 50 and over. The tinting of surgery was: D 0-D 3 51%, D 4-D 6 20%, D 7 and later 18%, and No surgery 11%. The overall management results were: Good (satisfactory result) 43%, Fair (moderately disabled) 18%, Poor (severely disabled + vegetative survival) 19%, and Death 20%. The outcome was strongly related to the level of consciousness, the rates of Good result decreasing from 71% (grades I-II) to 14% (grades III-IV) and to zero (grade V), and the mortality rates increasing respectively from 5% to 14% and 61%. The relationship between outcome and age was less marked: 54% Good result under 50 and 30% over 50. Out of the Grade V group, 56% could be operated upon and 44% died before surgery. No patient from the other two groups died before surgery. The literature concerning the Grading Systems published so far and the various prognostic factors are discussed.