Abstract WP427: Day Eight CT Perfusion Imaging for Evaluation of Delayed Cerebral Ischemia Risk and Decreased Length of Stay Following Aneurysmal Subarachnoid Hemorrhage
Objective: Hospital stay alone accounts for 2/3 the cost of aneurysmal subarachnoid hemorrhage (aSAH) management. Our objective was to assess the ability of CT perfusion (CTP) imaging to predict delayed cerebral ischemia (DCI) risk in those who are neurologically intact in order to safely decrease the length of hospital stay for low risk aSAH patients.
Methods: A retrospective analysis of all aSAH admitted to our neurological intensive care unit (NICU) from 3/2011-3/2012. Per our protocol all patients were admitted to the NICU for 10 days followed by a 4 day ward admission. Additionally, all patients underwent a CTP study on post-bleed day 8 to screen for evidence of radiographic vasospasm. DCI was defined as the presence of neurological deficit not attributable to other etiologies. All CTP images were interpreted by a Neuroradiologist. CTP was considered positive if there was evidence of match or mismatch. Mismatch was defined as decreased cerebral blood flow or increased mean transit time with associated blood volume loss of <20%.
Results: A total of 58 aSAH were admitted. Day 8 CTPs were performed on 42 (72%) with 71% female, mean age 52.21 (±13.25), mean Fisher 3.38 (2-4) and mean Hunt/Hess 2.39 (1-5). Eighteen (43%) patients had negative CTPs with baseline neurological exams. None of these 18 patients went on to develop DCI during their 14 day admission.
Conclusion: Our data shows that aSAH patients who are neurologically intact and have a negative post-bleed day 8 CTP are not at risk for DCI. We conclude that an 8 day NICU admission with an additional 2 day in-patient stay is sufficient to safely manage this patient population. Our data is limited by a small sample size and retrospective analysis. Future directions of research include additional prospective studies for reproducibility.
- © 2012 by American Heart Association, Inc.