Predictors of in-hospital mortality in traumatic subarachnoid hemorrhage: a nationwide study of 67,684 patients in Germany.

INTRODUCTION

Population-based data on incidence and mortality risk factors, particularly in very elderly patients with traumatic subarachnoid hemorrhage (tSAH) are limited. This study analyzed epidemiology, comorbidities, complications, age-specific incidence rates, and predictors of in-hospital mortality in patients with tSAH in Germany, with a focus on those aged ≥80 years.

MATERIAL AND

METHODS

This retrospective cross-sectional study included all hospitalized patients with tSAH (ICD-10 S06.6) in Germany from 2019 to 2022, using nationwide administrative data from the Institute for the Hospital Remuneration System (InEK-GmbH). Demographics, comorbidities, complications, diagnostic procedures, ICU treatment, and in-hospital mortality were analyzed. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using univariable analyses. Age-specific incidence rates were derived from Federal Statistical Office (Destatis) population data.

RESULTS

In a nationwide cohort of 67,684 tSAH patients, in-hospital mortality was 9.1%. The incidence of tSAH was 34.4 per 100,000 and increased sharply with age. Hypertension (44.5%) and atrial fibrillation (14.8%) were common. Mortality was higher in patients with atrial fibrillation (OR 1.86), cardiac pacemakers (OR 1.65), and three-vessel coronary artery disease (OR 1.54). Prolonged unconsciousness (>24 h) was the strongest predictor of death (OR 16.32), followed by cerebral edema (OR 4.70). Septic shock, renal failure, and traumatic shock carried the highest mortality risk.

DISCUSSION AND

CONCLUSION

tSAH is associated with substantial in-hospital mortality, particularly in very elderly patients and those with cardiac comorbidities. These predictors/associations may support risk stratification and early intensive care management.