Saudi Stroke Standards

Subarachnoid hemorrhage Purpose To ensure that immediate, appropriate assessment is carried out for spontaneous subarachnoid hemorrhage to ensure that the patient can receive the required treatment. Rationale Spontaneous subarachnoid hemorrhage, which is usually attributable to rupture of an intracranial aneurysm, is accountable for 3% of all strokes.16 There is some evidence that the mortality associated with SAH may have decreased during the past few decades, but it is still >25%.17 Immediate treatment for spontaneous subarachnoid hemorrhage patients can improve patient outcomes. The longer the patients are left without any treatment, the higher the chance he/she may get re-rupture from the vascular lesion or develop complications from the initial bleed (e.g. hydrocephalus, seizers, vasospasm, etc.) leading to mortality or long-term permanent damage. Standards 1. All adult patients with suspected spontaneous (non-traumatic) subarachnoid hemorrhage must have immediate assessment and investigations to establish a diagnosis, initiate treatment and determine eligibility for surgical or endovascular interventions. 2. All health care facilities will have a protocol outlining initial assessment, management and transfer protocols for SAH. 3. All patients with spontaneous subarachnoid hemorrhage should be managed using standardized guidelines and protocols in a comprehensive stroke hospital. 4. All patient with spontaneous subarachnoid hemorrhage must have immediate access to neuro-surgical expertise. 5. All patients with spontaneous subarachnoid hemorrhage should have rapid access to neurological imaging including vascular imaging and timely access to neuro-vascular expertise. 6. All patients with spontaneous subarachnoid hemorrhage should be admitted to a neurocritical care unit or equivalent. 7. All patients with spontaneous subarachnoid hemorrhage –regardless of their clinical status- should be immediately assessed then transferred to a comprehensive stroke hospital, where established guidelines and protocols are used to manage these patients in a multi-disciplinary therapy team. QM