Cost-effective outcome for treating poor-grade XXXX .

@entity1 @entity439 @entity510
BACKGROUND AND PURPOSE: The goal of this study was to prospectively assess outcome and cost for poor-grade @entity510 @entity1 presenting to a regional neurosurgical center (Addenbrooke's Hospital, Cambridge, UK) between 1994 and 2001. Outcome measures were clinical outcome at 6 months, number needed to treat (NNT) for favorable outcomes, and cost analysis. METHODS: Poor-grade @entity1 (World Federation of Neurological Surgeons grades 4 and 5) were transferred to the neurocritical care unit after intubation and ventilation. After resuscitation and drainage of ventricular cerebrospinal fluid for 24 hours, sedation was stopped, and @entity1 were assessed clinically. @entity1 with a Glasgow Motor Score (GMS) > or =4 underwent angiography and surgical treatment of culprit @entity439 . @entity1 with a subsequent GMS of 6 were not deemed poor grade and were discounted from the study. RESULTS: We deemed 166 ventilated @entity1 genuinely poor grade (mean age, 53.4 years; 94 @entity1 [56.6%]). Of these, 88 @entity1 (4<GMS<6; 53%) progressed to angiography and possible definitive treatment. Seventy-five @entity1 had an identifiable @entity439 , but only 64 survived for treatment. Operative mortality was 31.3%, and of the 44 survivors, 22 (34.4% of operated @entity1 ) achieved a favorable outcome. Favorable outcomes were more frequently seen in @entity1 than @entity1 (21.3% versus 6.9%) but were unrelated to @entity1 age. The NNT for 1 favorable outcome was 7 (male NNT, 15; female NNT, 5) at a cost of pound 84 336 per favorable outcome (female, pound 60 240; male, pound 180 720). CONCLUSIONS: Poor-grade @entity510 is associated with a high mortality but a significant subset of @entity1 can achieve favorable outcomes.
