Outcomes in a case series of elderly patients with aneurysmal subarachnoid hemorrhages in the Barrow Ruptured Aneurysm Trial (BRAT).



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BACKGROUND: Aneurysmal subarachnoid hemorrhage (aSAH) is debilitating in elderly patients, but literature about this population is scarce and clinical decision-making remains debated. Outcomes of elderly aSAH patients stratified by age and clinical presentation were analyzed.

METHODS: Patients treated for aSAH were retrospectively analyzed. Patients were trichotomized into a young cohort ([n= 268]) and two elderly cohorts (60-65 years [n=60] and ≥65 years [n=77]). The elderly cohorts were analyzed by poor or good scores at presentation (Hunt and Hess [HH] score >3 vs. ≤3, respectively) and poor functional outcome (modified Rankin Scale [mRS] score >2).

RESULTS: Of 137 elderly patients, 121 had a 6-year follow-up. The >65-year-olds (75% [52/69]) were more likely to have poor functional outcomes than the 60-65-year-olds (48% [25/52]) (OR 3.3, 95% CI 1.5-7.1; P=0.002). Among those with an HH score ≤3 at presentation (n=90), the >65-year-old cohort had poorer outcomes than the 60-65-year-old cohort at 6-year follow-up (69% [35/51] vs. 36% [14/39], respectively; OR 3.9, 95% CI 1.6-9.4; P=0.003). Among patients with an HH score >3, no statistically significant differences in functional outcome were observed between the >65-year-old (n=18) and 60-65-year-old (n=13) cohorts.

CONCLUSION: Elderly patients with aSAH are at high risk for poor functional outcomes. However, among those presenting with good HH scores, younger-elderly patients (ages 60-65 years) tend to fare better than older-elderly patients (ages >65 years). Elderly patients presenting with high-grade aSAH fare poorly regardless of age, which can inform clinical decision-making and prognostication.

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World Neurosurg



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