Diagnosis and care delivery to patients with ruptured cerebral aneurysms living in remote rural areas

Abstract

Relevance. Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition. Incorrect diagnosis of aSAH in a rural medical institution can lead to a delay in surgical treatment and worse outcomes of the disease in patients with ruptured cerebral aneurysms (CA). Objective. Analysis of diagnostic algorithms and evaluation of outcomes of surgical treatment of ruptured cerebral aneurysms in a region with a vast sparsely populated territory. Materials and methods. A retrospective analysis of the results of surgical treatment of 145 patients with aSAH, hospitalized in the Regional Vascular Center (RVC) in Yakutsk city, for 2017–2018 was carried out. The subjects were divided into 3 groups: group 1 — rural residents who were diagnosed with aSAH in rural medical institutions; group 2 — rural residents who were incorrectly diagnosed in rural medical institutions; group 3 — residents of Yakutsk who were hospitalized in the RVC by emergency medical services. Results. The study included 145 patients with aSAH. All patients underwent surgical treatment. The majority of patients (91 patients, i.e. 62.8 % of the total number of patients) were brought to the RVC by air medical service from the regions of the Republic. An erroneous diagnosis at the initial health encounter was established in 12 cases (8.3 % of the total number of aSAH cases), including in 11 cases in medical institutions of small villages (91.7 %) and only in 1 case in the Central District Hospital (8.3 %). Conclusions. During the initial health encounter of patients with aSAH, incorrect diagnoses were established in 8.3 %, of which 91.7 % were established in medical institutions of small villages. Emergency hospitalization of patients with suspected aSAH in the RVC ensures correct diagnosis of the disease and timely neurosurgical treatment.