Time to treatment and outcomes for aneurysmal subarachnoid haemorrhage in metropolitan versus remote areas: A Queensland population analysis

Abstract

BACKGROUND: Aneurysmal subarachnoid haemorrhage (aSAH) is a life-threatening condition that demands prompt neurosurgical intervention. In Australia, the vast geographic distances and the substantial proportion of the population living in rural or remote areas may hinder access to timely care, potentially influencing patient outcomes. Although medical retrieval services are well-established and regional centres provide primary care, patients with aSAH in remote areas may experience poorer outcomes compared to those in urban centres. This study aims to assess clinical outcomes between patients from remote regions and major cities in a prospective cohort analysis. METHODS: Patients presenting with aSAH to the Royal Brisbane and Women's Hospital within 3 days post-ictus were prospectively enrolled to an aneurysmal subarachnoid haemorrhage database. Demographic, clinical, management, and outcome data were collected. Primary outcomes including the modified Rankin Scale (mRS), mortality, and the need for permanent cerebrospinal fluid (CSF) diversion, were assessed at 1-year post-ictus. RESULTS: A total of 114 patients met the inclusion criteria, with 57 patients (50 %) retrieved from regional or remote centres (ASGS 2-5). Average retrieval distance was 349.1 km (230.6-467.5 km). No significant differences were observed in 1-year mRS (1.8, 1.2-2.3 vs 1.2, 0.8-1.6, p = 0.09), mortality (10.5 % vs 3.5 %, 0.14), or the need for permanent CSF diversion (26.3 %, 17.9 %, p = 0.28) between the patients in major cities or rural centres respectively. Furthermore, time to ventriculostomy was not significantly different. CONCLUSION: Patients with aSAH from regional and remote areas of Queensland do not experience worse clinical outcomes compared to those from major cities. The presence of robust medical retrieval services and primary care infrastructure, combined with the centralisation of neurosurgical expertise, likely contributes to comparable outcomes despite geographic challenges.