Outcomes related to symptomatic vasospasm after aneurysmal subarachnoid haemorrhage before-and-after the introduction of neuro-interventional radiology service

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Hypothesis: We hypothesize that the introduction of NIR service at our hospital is associated with a significant reduction in unfavorable neurological outcomes related to SV among patients with SAH. Our secondary hypothesis is that there is an association between clinical outcomes and the length of ICU stay prior to the surgical or endovascular management of SAH and that prior to suspected SV. Aims: Our primary aim is to compare differences in neurological outcomes, among patients who were admitted with SAH and were suspected to have SV, during a period of 30 months before-and-after the introduction of NIR service at a university-affiliated tertiary referral hospital. Primary objective: To assess and compare modified Rankin scores (mRS), at/or closest to 6 months after hospital discharge, among patients with SAH and suspected SV during a period of 30 months before and 30 months after the introduction of NIR service at our hospital. Secondary objectives: * To assess whether the ‘after’ phase was associated with lower incidence of SV, lower incidence of cerebral infarcts, shorter length of hospital admission, and lower mortality as compared to that during the ‘before’ phase. * To assess whether the time spent with unsecured aneurysm, or the time spent in non-critical care areas prior to the onset of SV have any relationship with mRS scores and mortality. Methods: This is a retrospective before-and-after study at a multidisciplinary academic ICU at John Hunter Hospital, Newcastle. The study will be conducted over a period of 12 months during which the required data will be collected retrospectively for the 1 Jul 2010 to 30 Dec 2012 period and then for the 1 Jan 2013 to 30 June 2015 period. All consecutive eligible patients admitted during the two periods will be enrolled in the study. Besides demographics, severity scores and clinical outcomes, the study will also collect data related to process-of-care during the two periods. Significance: The health and financial burden of long-term complications due to SV among patients with SAH are substantial. This observational study will inform the overall clinical outcomes for these patients in our practice. This may help us benchmark our clinical outcomes against those reported in international studies. This baseline data might also be useful to design an interventional trial investigating strategies to improve quality of care delivered to this patient group.