Brain haemorrhage treatment delays ‘harming patients’

Posted 25/11/2013

Delays in the diagnosis and treatment of patients with brain haemorrhages caused by aneurysms, especially at weekends, may be harming patient care.  A report says GPs are failing to recognise symptoms, and rehab support and out-of-hours hospital care is poor. However, the National Confidential Enquiry into Patient Outcome and Death report  (NCEPOD) did find good care in 58% of cases.Subarachnoid haemorrhages affect 5,000 people in the UK each year. The NCEPOD report is based on the confidential analysis of 427 cases of aneurysmal subarachnoid haemorrhage, covering England, Wales, Northern Ireland, the Channel Islands and the Isle of Man. Overall, the report describes the massive change in the care of patients with this type of haemorrhage as “a welcome and real achievement”. It also says 90% of hospitals were found to be able to provide CT head scans seven days a week, and 86% of patients were treated using the latest endovascular techniques.In other areas, it found patient care to be lacking. Weekend delays included GPs failing to recognise a severe headache as a potential symptom of a subarachnoid haemorrhage and 18% of patients not receiving a neurological examination when admitted to hospital. Once in hospital, delays in treatment were found to be more common at weekends with 30% of patients receiving care within 24 hours of admission compared with 70% on weekdays.An aneurysmal subarachnoid (or brain) haemorrhage is a type of stroke caused by bleeding in and around the brain.  It results from the rupture of a cerebral aneurysm – a ballooning in an artery wall, causing it to thin and become weak. Symptoms include a sudden and very severe headache, being sick, seizures and loss of consciousness. Survival outcomes are poor. Half of patients die within a month and only 25% go on to live a normal life. Aneurysmal subarachnoid haemorrhages account for 5% of all strokes in the UK.The NCEPOD report found that rehabilitation care, after surgery and following discharge from hospital, could also be improved.Prof Michael Gough, co-author of the report and a consultant vascular surgeon, said: “Many aneurysmal subarachnoid haemorrhage patients will be dependent for help with their daily living activities for the rest of their lives. So it is vital that all patients not only receive early in-patient rehabilitation, but also rehab support that continues in the community”.The report recommends that hospitals be linked to a specialist neurological centre in their region which could treat patients and that standard procedures of care be used to improve diagnosis and management of patients. Dr Alistair Douglas, president of the Society for Acute Medicine and a consultant at Ninewells Hospital in Dundee, said that although acute headaches were a common complaint of people presenting at A&E, only a small minority (10% or fewer) were caused by an aneurysmal subarachnoid haemorrhage or another serious condition. He added that there were many positive aspects to the report.

“The good news is that the majority of cases were felt to have no room for improvement in care, 96% received adequate investigation in secondary care and there was no delay in CT scan requesting in 90% of cases. But there were cases where care could have been better and all involved in acute medicine are encouraged to read the report.”Julie Crossley, a medical injury lawyer from Ashtons Legal comments: “Sadly we see delays all too often and in these cases the outcomes can be catastrophic”.