About the problem of opportune admission of patients with cerebral aneurysms to specialized neurosurgical department of N.N. Burdenko Neurosurgical Institute
Belousova, O.B.; Okishev, D.N.
Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko 2009(1): 29-32; discussion 32-3
2009
ISSN/ISBN: 0042-8817 PMID: 19507311 Document Number: 634662
The problem of emergent transportation and early surgical care of patients with aneurysmal SAH is well recognized due of high risk of fatal rebleeding. Currently, this problem is resolved in most of developed countries. The purpose of the study was to analyze causes of late admission of patients with ruptured cerebral aneurysms to highly specialized clinics such as Burdenko Neurosurgical Institute. The work is based on data of 101 patients with cerebral aneurysms admitted in 2007 within time period exceeding one month after SAH. 14% of patients were submitted from Moscow and near-by regions, 86% -- from far-off regions of the country. 29.7% had the history of recurrent bleedings. Primary admission to the local hospital in 65% of patients was on Day 0 and in 80% -- within the first week after SAH. Leading causes of the delay of primary admission were underestimation of the severity of patient's status by ambulance staff (52.5%) and delayed applying for medical help by patient (42.5%). After admission, in most cases treatment was conservative regardless of patients' condition. The median time of aneurysm diagnosis was 1.6 months and the median time to admission to Burdenko Neurosurgical Institute -- 3.7 months. The need for better organization of emergent care in cases of SAH is obvious. Possible decisions lay in establishing training programs for physicians; making neurosurgical care more accessible, developing neurovascular units in regional hospitals and easy-quoted federal financing coverage.