過疎地域におけるくも膜下出血治療の現状と問題点(<特集>地域医療における脳卒中診療の現状と問題点)  [in Japanese] Management of Aneurysmal Subarachnoid Hemorrhage in Local Area(<Topics> Medical Care for Stroke in Community Health)  [in Japanese]

The population of our local area is about 300,000, and 12 hospitals have emergency rooms, but all neurosurgical cases are transferred to our hospital. Subarachnoid hemorrhage (SAH) cases that do not have a mass lesion do not need immediate surgery. So we carefully regulate the transfer of patients according to their condition and our clinical circumstances and patient care priorities at the time of consultation. We retrospectively evaluated the relationship between the time required for transfer and outcome of SAH in our community. From January 1, 2002, to June 30, 2005, our hospital admitted 97 SAH cases with ruptured cerebral aneurysm. We analyzed the relationships between time required for admission and clinical outcome at 30 days after major SAH in the patients who were operated within 72 hours after the onset of SAH (n=82). We postponed 22 admissions (26.8%) for about 12 hours due to poor Hunt-Kosnik grade (7 cases) or late-night consultation (15 cases). The relationship between Hunt-Kosnik grade and time required for admission was not significant. The relationship between outcome and time required for admission was also not significant. However, the time required for admission tended to be shorter in proportion to the severity of SAH or poor outcome. Misdiagnosis of SAH (21.6%) and the patients' ability to endure the pain prolonged the preadmission periods. Our control of admission does not influence the outcome of SAH. Neurosurgeons need to enlighten citizens about this potentially fatal disease and educate physicians about the importance of sudden onset of severe headache as an indication of SAH and the need for emergency transfer to a neurosurgical treatment facility.