Study Design:

• Retrospective cohort study including all patients who presented to the Royal Brisbane and Women’s Hospital with aSAH between October 2007 and October 2010 that subsequently underwent an endovascular coiling procedure to secure the ruptured aneurysm, and did not also undergo surgical management (113 patients)
• Outcome of interest
  • endovascular treatment for delayed cerebral vasospasm (ie. intra-arterial (IA) verapamil infusion with or without angioplasty)
• Patients were identified from departmental records, data was collected from PACS using an in-house search engine, images and radiology reports
• Diagnosis of subarachnoid haemorrhage was confirmed by non-contrast head CT scan
• Fisher score was ascertained by review of presentation non-contrast head CT scan
• Patients with a Fisher score of 1 (no blood detected) - diagnosis was confirmed by either lumbar puncture or combination of convincing history with angiographic appearance of an aneurysm
• If multiple conflicting WFNS scores existed, the highest score was taken
• Exclusions
  • 1 patient due to lack of access to the initial non-contrast head CT scan images

Statistical Method:

• Categorical variables were described using frequencies and percentages and analysed using chi squared or Fishers exact when appropriate
• Fisher and WFNS scores were then dichotomized into high and low
• Bivariate logistic regression models were used to assess association and a multivariable model was created by including variables with a p-value < 0.2

aSAH management at this institution:

• Presentation occurs either directly to our Emergency Department in an undifferentiated fashion, or are referred from a peripheral hospital after the diagnosis is confirmed
• Management is in the Intensive Care Unit until the aneurysm is secured either by surgical clipping or endovascular embolisation, and also if further therapy (whether medical or endovascular) is required for cerebral vasospasm
• When clinically appropriate, patients are transferred to the Neurosurgical ward under the care of the Neurosurgical team
• All patients are treated with systemic oral nimodipine and avoidance of hypovolaemia from admission
• Hyperdynamic therapy is instituted at the onset of neurologic symptoms suggestive of cerebral vasospasm