Clinical assessment of deficits after SAH: hasty neurosurgeons and accurate neurologists

Abstract

For survivors of aneurysmal subarachnoid hemorrhage (SAH), somatic and cognitive deficits can affect long-term outcomes. We were interested in comparing the deficits identified in SAH patients, including cognitive deficits, at discharge by neurosurgeons and deficits identified by neurologists upon admission to the rehabilitation unit on the same day. The assessment of deficits might have an impact on referring patients to rehabilitation. This retrospective study included 494 SAH patients treated between 2005 and 2010. Of these, 50 patients were discharged to an affiliated rehabilitation unit. Deficits were grouped into 18 categories and summarized into three groups: major somatic, minor somatic, and cognitive deficits. Major somatic deficits were identified in 16 and 20 patients (p = 0.53), minor somatic deficits in 16 and 44 (p \ 0.0001) patients, and cognitive deficits in 36 and 45 (p \ 0.04) patients by neurosurgeons and neurologists, respectively. The absolute number of deficits in daily activities identified by the neurosurgeon and neurologist were 21 and 31 major somatic deficits (p = 0.2), 18 and 97 minor somatic deficits (p \ 0.0001), and 61 and 147 cognitive deficits (p \ 0.0001), respectively. Significant differences in assessment of cognitive and minor somatic deficits between neurosurgeons and neurologists exist. Based on these findings, it is evident that for the neurosurgeon, there needs to be an increased awareness of the assessment of cognitive deficits and a more routine interdisciplinary approach, including the use of neuropsychological evaluations, to ensure a better triage of patients to rehabilitation or for discharge home.

Screening tools for early neuropsychological impairment after aneurysmal subarachnoid hemorrhage

“…During the hospital period following aSAH, the outcome of survivors is often evaluated only by functional grading scales such as the modified Ranking Scale (mRS) [4] or Glasgow Outcome Scale (GOS) [5]. Despite their advantages in terms of standardizing the outcome assessment, some criticism has been raised regarding their insensitivity to neuropsychological deficits (NPDs) [6][7][8]. In fact, NPDs are the most common form of disabilities after aSAH; nearly half of the independent patients suffer from these impairments, causing difficulties in activities of daily living (ADLs) and return to premorbid work [9][10][11].…”

Current practice in neuropsychological outcome reporting after aneurysmal subarachnoid haemorrhage

“…Besides neurological disability, neuropsychological deficits (NPD) are among the main reasons for mid-and longterm disability in aSAH survivors [2,9,39]. The incidence is high, with NPD in one or more cognitive domains shown to occur in up to 60% of patients despite otherwise good or excellent neurological outcome according to the Glasgow Outcome Scale (GOS) [14,16]. NPD are most frequent within the first 3 months after aSAH [2,36].…”

“…The high incidence and the impressive relevance of NPD in aSAH patients on the one hand and the small number of studies reporting NPD on the other hand constitute a strong contradiction. In addition neurosurgical assessment has been reported to be insufficient in detecting NPD [14].…”