Looking for Statistic on Aneurysm Rupture Survival Rates

Karen Cosby kcosby40 at GMAIL.COM
Sat Apr 1 17:35:09 UTC 2017


What is lacking in this discussion is that perhaps we have become so used
to diagnostic errors that we forget that much of the time we actually do
well.  This case is not an exception, just dramatic with a high potential
for a catastrophic outcome.  It is good to celebrate and understand why
they were successful, but also recognize that there is always great risk
when the outcomes are so tenuous.

On Sat, Apr 1, 2017 at 12:12 PM, Mayer, Thom <tmayer at best-practices.com>
wrote:

> Hi Bob
>
> I'm an emergency physician who practices at a nationally recognized level
> 1 trauma center. Perhaps more importantly our oldest son, Josh, had a 5 cm
> basilar artery aneurysm so I know this territory fairly well and also
> discussed it with Josh's neurosurgeon
>
> The answer on prognosis of brain aneurysms is, like so much in medicine,
> "It depends."  In this case it depends on the size and location of the
> lesion, the speed of recognition, the patient's underlying health status,
> and the skill and experience of not only the the vascular neurosurgeon
> and/or interventional radiologist ( both of which are specialties unto
> themselves) but the team of people caring for her, including the
> EMS/paramedics who instantly recognized she needed specialty care
>
> For brevity's sake, the prognosis ranges from extremely high for small,
> focal aneurysms which can often be treated with coils through a catheter in
> which > 90% survival with no or minimal deficits in young people to nearly
> uniformly poor results for massive hemorrhages or large brain stem
> aneurysms (like Josh's-although his story is great as I ll share).
>
> So I would say she is a very lucky young lady on every front but the kind
> of work the team did is actually extremely common.  As an aside, the team
> undoubtedly uses the principles of crew resource management as virtually
> all trauma centers do
>
> And Josh's case was discussed by all of the best vascular neurosurgeons in
> the world. Only one, Dr Robert Spetzler of Barrow Neurological Institute,
> would even consider operating since the basilar artery feeds the brain stem
> and the entire artery was an aneurysm
>
> Not to get too technical but he clipped BOTH vertebral arteries, diverting
> all anterograde flow through the collateral circulation creating retrograde
> flow, thereby keeping precisely the right amount of flow to clot the
> aneurysm but keep the basilar artery open. For the docs on the thread, that
> is a bold and stunning move that very few docs could pull off
>
> And despite a sometimes rocky post-op course, Josh is 12 years out,
> married with 3 lovely daughters my wife and I enjoy every weekend!
>
> Hope this helps
>
> My best to your friend and his daughter
>
> I rarely post but I enjoy the discussion
>
> Best
>
> Doc
> Thom Mayer MD
> Medical Director
> NFL Players Association
>
> Sent from my iPhone
>
> > On Mar 31, 2017, at 5:14 PM, Bob Latino <blatino at RELIABILITY.COM> wrote:
> >
> > Good point!  How does the initial Dx of first responders (if at all)
> influence the initial Dx of the receiving ED physician, when time is of the
> essence?
> >
> > I didn't know if Neurosurgeons participated on this forum, but I thought
> I would check.
> >
> > Thanks
> >
> > Robert J. Latino, CEO
> > Reliability Center, Inc.
> > 1.800.457.0645
> > blatino at reliability.com
> > www.reliability.com
> >
> >
> >
> > -----Original Message-----
> > From: Hueth, Kyle D. [mailto:kyle.hueth at aruplab.com]
> > Sent: Friday, March 31, 2017 10:42 AM
> > To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.
> IMPROVEDIAGNOSIS.ORG>; Bob Latino <blatino at reliability.com>
> > Subject: Re: [IMPROVEDX] Looking for Statistic on Aneurysm Rupture
> Survival Rates
> >
> > Wow! What a fortunate outcome.  I'm interested to hear the answer to
> your question and would like to pose another.
> >
> > Is there data on the appropriate initial diagnosis/evaluation by
> emergency responders when it comes to determining the level of care a
> patient will need, as was the differentiator in this case?  Outcomes tied
> to this early factor would be interesting to know.
> >
> > Best,
> >
> > Kyle Dean Hueth, MLS(ASCP)
> > Healthcare Consultant
> >
> > Sent from my iPhone
> >
> > On Mar 31, 2017, at 05:45, Bob Latino <blatino at RELIABILITY.COM<mailto:
> blatino at RELIABILITY.COM>> wrote:
> >
> > Two weeks ago, a good friend of mine's daughter suffered the rupture of
> an aneurysm at 35 y/o.  She was nonresponsive for 12 minutes and
> transported to our local Trauma 1 hospital which was about 40 minutes.
> Brain surgery was performed within 8 hours of arrival at the hospital to
> put a stent in place.
> >
> > Amazingly she 1) survived, 2) will be released from the hospital
> tomorrow and 3) has no apparent deficits at this time.  She still has to
> take it very slow (she is very fit Physical Therapist) for about 4 months
> and has residual headaches which will reportedly fade in due time.
> >
> > Does anyone have any stats of the survival rates of such a traumatic
> event and to survive with no apparent deficits?
> >
> > The family is obviously overwhelmingly grateful to God and the hospital
> staff, but I was curious as to how uncommon it is to survive an aneurysm?
> >
> > This is related to SIDM in a sense because the initial belief was that
> she was having a seizure (epilepsy ran in the family).  They were going to
> transport her to the local hospital which would not have been able to
> properly treat a ruptured aneurysm (and the time delay likely would have
> killed her) in a timely manner.
> >
> > The Emergency Crew staff recognized the acuity of her case and decided
> to transport her to the Trauma 1 center a farther distance away.  Luckily
> it was the right decision.
> >
> > Thanks for any feedback on this question.
> >
> > Bob Latino
> >
> > Robert J. Latino, CEO
> > Reliability Center, Inc.
> > 1.800.457.0645
> > blatino at reliability.com<mailto:blatino at reliability.com>
> > www.reliability.com<http://www.reliability.com>
> > <image001.jpg><https://www.linkedin.com/company/958495?trk=tyah&trkInfo=
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> 2Cidx%3A1-1-1%2CtarId%3A1464096807851%2Ctas%3Areliability%20center%2C%
> 20inc.>
> >
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