Clinical Presentation to the Emergency Department Predicts Subarachnoid Hemorrhage-Associated Myocardial Injury

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d7014893e153">Introduction</h5> <p id="P1">Aneurysmal subarachnoid hemorrhage is frequently seen in emergency departments. Secondary injury such as subarachnoid hemorrhage-associated myocardial injury (SAHMI) affects one-third of survivors and contributes to poor outcomes. SAHMI is not attributed to ischemia from myocardial disease but can result in hypotension and arrhythmias. It is important that emergency nurses recognize which clinical presentation characteristics are predictive of SAHMI to initiate proper interventions. The aim of this study was to determine whether clinical presentation of aSAH patients to the emergency department predict SAHMI as defined by troponin I ≥0.3ng/ml. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d7014893e158">Methods</h5> <p id="P2">This was a prospective descriptive study. SAHMI was defined as troponin I ≥0.3ng/ml. Predictors included: demographics and clinical characteristics, injury severity, admission 12-lead ECG, initial emergency department vital signs, and pre-hospital symptoms at time of aneurysm rupture. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d7014893e163">Results</h5> <p id="P3">Of 449 patients, 126 (28%) had SAHMI. Patients with SAHMI were more likely to report seizures and unresponsiveness, with significantly lower Glasgow coma score, and higher proportion of Hunt and Hess grades 3-5 and Fisher grades III and IV (all <i>p</i> &lt;.05). SAHMI patients had higher atrial and ventricular rates and longer QTc interval on initial ECG <i>(p</i> &lt;.05). On multivariable logistic regression, poor Hunt and Hess grade, report of prehospital unresponsiveness, lower admission Glasgow coma score, and longer QTc interval were significantly and independently predictive of SAHMI ( <i>p</i>&lt;.05). </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d7014893e177">Discussion</h5> <p id="P4">Components of the clinical presentation of subarachnoid hemorrhage to the emergency department predict SAHMI. Identifying SAHMI patients in the emergency department can be helpful in determining surveillance and care needs, and informing transfer unit care. </p> </div>