{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T11:31:20Z","timestamp":1792582280358,"version":"4.5.0"},"reference-count":29,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2015,2]]},"abstract":"\nOBJECT<\/jats:title>\nWhile the incidence of a recurrent hemorrhage is highest within 24 hours of subarachnoid hemorrhage (SAH) and increases with the severity of the clinical grade, a recurrent hemorrhage can occur anytime after the initial SAH in patients with both good and poor clinical grades. Therefore, the authors adopted a 24-hour-a-day, formal protocol, emergency treatment strategy for patients with ruptured aneurysms to secure the aneurysms as early as possible. The incidences of in-hospital rebleeding and clinical outcomes were investigated and compared with those from previous years when broadly defined early treatment was used (< 3 days of SAH).<\/jats:p><\/jats:sec>\n\nMETHODS<\/jats:title>\nDuring an 11-year period, a total of 1224 patients with a ruptured aneurysm were managed using a strategy of broadly defined early treatment between 2001 and 2004 (Period B, n = 423), a mixture of early or emergency treatment between 2005 and 2007, and a formal emergency treatment protocol between 2008 and 2011 (Period A, n = 442). Propensity score matching was used to adjust the differences in age, sex, modified Fisher grade, World Federation of Neurosurgical Societies (WFNS) clinical grade at admission, size and location of a ruptured aneurysm, treatment modality (clip placement vs coil embolization), and time interval from SAH to admission between the two time periods. The matched cases were allotted to Group A (n = 280) in Period A and Group B (n = 296) in Period B and then compared.<\/jats:p><\/jats:sec>\n\nRESULTS<\/jats:title>\nDuring Period A under the formal emergency treatment protocol strategy, the catheter angiogram, endovascular coiling, and surgical clip placement were started at a median time from admission of 2.0 hours, 2.9 hours, and 3.1 hours, respectively. After propensity score matching, Group A showed a significantly reduced incidence of in-hospital rebleeding (2.1% vs 7.4%, p = 0.003) and a higher proportion of patients with a favorable clinical outcome (modified Rankin Scale score 0\u20133) at 1 month (87.9% vs 79.7%, respectively; p = 0.008). In particular, the patients with good WFNS grades in Group A experienced significantly less in-hospital rebleeding (1.7% vs 5.7%, respectively; p = 0.018) and better clinical outcomes (1-month mRS score of 0\u20133: 93.8% vs 87.7%, respectively; p = 0.021) than the patients with good WFNS grades in Group B.<\/jats:p><\/jats:sec>\n\nCONCLUSIONS<\/jats:title>\nPatients with ruptured aneurysms may benefit from a strategy of emergency application of surgical clip placement or endovascular coiling due to the reduced incidence of recurrent bleeding and improved clinical outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.9.jns131784","type":"journal-article","created":{"date-parts":[[2014,11,18]],"date-time":"2014-11-18T09:01:48Z","timestamp":1416301308000},"page":"383-391","source":"Crossref","is-referenced-by-count":70,"title":["Formal protocol for emergency treatment of ruptured intracranial aneurysms to reduce in-hospital rebleeding and improve clinical outcomes"],"prefix":"10.3171","volume":"122","author":[{"given":"Jaechan","family":"Park","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Research Center for Neurosurgical Robotic Systems, Kyungpook National University, Daegu; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyunjin","family":"Woo","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong-Hun","family":"Kang","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Radiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong-Sun","family":"Kim","sequence":"additional","affiliation":[{"name":"Radiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Research Center for Neurosurgical Robotic Systems, Kyungpook National University, Daegu; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Im Hee","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, School of Medicine, Catholic University of Daegu, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang Gyu","family":"Kwak","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, School of Medicine, Catholic University of Daegu, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns131784","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.1016\/j.jocn.2007.03.021","article-title":"Blister-like aneurysms of the supraclinoid internal carotid artery: challenging endovascular treatment with stent-assisted coiling","volume":"15","author":"Ahn","year":"2008"},{"key":"b2-jns131784","series-title":"Neurosurgery","first-page":"43","article-title":"Feasibility and limitations of endovascular coil embolization of anterior communicating artery aneurysms: morphological considerations","volume":"59","author":"Birknes","year":"2006"},{"key":"b3-jns131784","series-title":"J Korean Neurosurg Soc","doi-asserted-by":"publisher","first-page":"119","DOI":"10.3340\/jkns.2010.47.2.119","article-title":"Aneurysmal rebleeding: factors associated with clinical outcome in the rebleeding patients","volume":"47","author":"Cha","year":"2010"},{"key":"b4-jns131784","series-title":"Neurosurgery","first-page":"336","article-title":"Timing of aneurysm surgery in subarachnoid hemorrhage: a systematic review of the literature","volume":"50","author":"de Gans","year":"2002"},{"key":"b5-jns131784","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"35","DOI":"10.3171\/jns.1996.84.1.0035","article-title":"Ultra-early rebleeding in spontaneous subarachnoid hemorrhage","volume":"84","author":"Fujii","year":"1996"},{"key":"b6-jns131784","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/j.wneu.2011.10.049","article-title":"Reflections on the benefits and pitfalls of ultra-early aneurysm treatment after subarachnoid hemorrhage","volume":"77","author":"Gooderham","year":"2012"},{"key":"b7-jns131784","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"935","DOI":"10.1227\/NEU.0b013e3181ebaa36","article-title":"Short-term antifibrinolytic therapy before early aneurysm treatment in subarachnoid hemorrhage: effects on rehemorrhage, cerebral ischemia, and hydrocephalus","volume":"67","author":"Harrigan","year":"2010"},{"key":"b8-jns131784","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"551","DOI":"10.3171\/2008.8.17657","article-title":"Endovascular treatment of very small intracranial aneurysms. 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