Introduction: We propose that patients greater than 80 years old that present with a SAH decompensate to over the course of 3-5 days regardless of treatment. There has been anecdotal evidence that this decline may more accurately predict outcome than admission Hunt Hess grade (HH).

Methods: We retrospectively reviewed a prospectively collected database of 4204 patients presenting with aneurysmal subarachnoid hemorrhage (aSAH). Of these, 86 were found to be over 80 years of age at the time of presentation. Patients were grouped by survival at time of discharge as well as SAH day of decline. Groups were analyzed for presentation characteristics, decline characteristics, and outcome at discharge. Statistical analysis was performed with Fisher’s exact test, Student T-test, and Goodman and Kruskal Lambda where appropriate.

Results: Twenty-two of 35 patients dying declined during hospitalization, while 25 of the 51 patients surviving declined (55% of total declined). HH 3.1 and 2.18 (p=0.0009) for those dying and surviving, respectively. HH grade at time of decline was the most predictive of death for the two groups, 4.6 vs. 3.52(p=0.0001). A majority of those declining in both groups had an unclear cause for their decline. The group of individuals with early decline (on or before SAH day 3) comprised 29 patients (average age 84.5), while those declining late (on or after SAH day 4) comprised 56 patients (average age 83.3). HH on admission was 3.1 and 2.3 (p=0.0080), with death occurring before discharge in 23 and 12 (p=0.0001) for early and late decline, respectively. Early decline was found to be more predictive of death than admission HH (X2=26.427,p=0.000 vs X2=7.617,p=0.0079)

Conclusions: Patients older than 80 years old presenting with an aSAH frequently decline in a delayed fashion despite treatment. SAH day of decline may be a better predictor of outcome than presenting HH.

Patient Care: Giving expected outcomes for octogenarians presenting with aSAH.

Learning Objectives: 1)Patients >80 yo presenting with aSAH frequently decline in a delayed fashion not associated with vasospasm, stroke, rehemorrhage, or because of new post-op deficit. 2)Delayed HH score is more predictive of outcome than initial HH score

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