This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kassell, N. F. Articles by Mazuz, H. Search for Related Content PubMed PubMed Citation Articles by Kassell, N. F. Articles by Mazuz, H.

Stroke, Vol 16, 587-590, Copyright © 1985 by American Heart Association

ARTICLES

Delay in referral of patients with ruptured aneurysms to neurosurgical attention

NF Kassell, GL Kongable, JC Torner, HP Adams Jr and H Mazuz

Aneurysmal subarachnoid hemorrhage is a neurosurgical emergency. Early medical intervention is axiomatic for minimizing rebleeding and ischemia from vasospasm and achieving optimum results. The purpose of this study was to document the length and causes of the delay in referral which occur in patients following aneurysmal subarachnoid hemorrhage. The case histories of 150 consecutive patients admitted to The University of Iowa with proven ruptured aneurysms were studied. Medical records from The University of Iowa and referring hospitals were reviewed, and patients, families, and referring physicians interviewed. Overall, only 36% were referred within 48 hours of their first clear cut, recognizable sign or symptom of subarachnoid hemorrhage. Median time to referral was 3.6 days. Delay was due to physician diagnostic problems in 37%, delayed referral policy in 23%, unstable patient condition in 7%, failure of patients to recognize severity of illness in 8%, and logistical reasons in 12%. These data suggest that a large proportion of patients have a delay in achieving definitive neurosurgical care following aneurysm rupture, and that for the most part this delay is avoidable. More emphasis must be placed on public health and primary physician education regarding subarachnoid hemorrhage.

This article has been cited by other articles:

				M. J. Vermeulen and M. J. Schull Missed Diagnosis of Subarachnoid Hemorrhage in the Emergency Department Stroke, April 1, 2007; 38(4): 1216 - 1221. [Abstract] [Full Text] [PDF]

				J. A. Edlow Diagnosis of Subarachnoid Hemorrhage: Are We Doing Better? Stroke, April 1, 2007; 38(4): 1129 - 1131. [Full Text] [PDF]

				R. G. Kowalski, J. Claassen, K. T. Kreiter, J. E. Bates, N. D. Ostapkovich, E. S. Connolly, and S. A. Mayer Initial Misdiagnosis and Outcome After Subarachnoid Hemorrhage JAMA, February 18, 2004; 291(7): 866 - 869. [Abstract] [Full Text] [PDF]

				H. Ohkuma, H. Tsurutani, and S. Suzuki Incidence and Significance of Early Aneurysmal Rebleeding Before Neurosurgical or Neurological Management Stroke, May 1, 2001; 32(5): 1176 - 1180. [Abstract] [Full Text] [PDF]

				J. A. Edlow and L. R. Caplan Avoiding Pitfalls in the Diagnosis of Subarachnoid Hemorrhage N. Engl. J. Med., January 6, 2000; 342(1): 29 - 36. [Full Text] [PDF]

				P. L. Mayer, I. A. Awad, R. Todor, K. Harbaugh, G. Varnavas, T. A. Lansen, P. Dickey, R. Harbaugh, and L. N. Hopkins Misdiagnosis of Symptomatic Cerebral Aneurysm: Prevalence and Correlation With Outcome at Four Institutions Stroke, September 1, 1996; 27(9): 1558 - 1563. [Abstract] [Full Text]