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

Fung, Christian ; Beck, Jürgen ; Lauber, Lara ; Müri, René ; Raabe, Andreas ; Nyffeler, Thomas

In: Journal of Neurology, 2012, vol. 259, no. 10, p. 2198-2201

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    Title
    • Clinical assessment of deficits after SAH: hasty neurosurgeons and accurate neurologists
    Author
    • Fung, Christian. Department of Neurosurgery, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland
    • Beck, Jürgen. Department of Neurosurgery, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland
    • Lauber, Lara. Department of Neurosurgery, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland
    • Müri, René. Department for Cognitive and Restorative Neurology, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland
    • Raabe, Andreas. Department of Neurosurgery, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland
    • Nyffeler, Thomas. Department for Cognitive and Restorative Neurology, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:313598
    Summary
    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