Cookies are disabled so parts of this website may not function correctly, read more about cookies and how to enable them here  

21 Nov 2013


In 2009 the Society of British Neurological Surgeons (SBNS) submitted a proposal to NCEPOD 
for a comprehensive study of the management and outcome of aneurysmal subarachnoid 
haemorrhage (aSAH). The study was accepted early in 2011 and the work was undertaken 
last year. The study is unique in that it has tracked a cohort of aSAH patients through from 
their initial diagnosis and subsequent specialist care to their final outcome, be that 
rehabilitation and recovery or death. The study has focused on identifying remediable factors 
in the care of aSAH patients that might improve outcomes. 

Recent studies have confirmed that the case fatality of aSAH in the United Kingdom has been 
declining steadily over the last 10 years and that the outcomes of UK patients now match 
those of the best institutions in Europe and North America. Nevertheless, the NCEPOD study 
demonstrates that further improvements could be achieved by earlier diagnosis, prompt 
transfer to regional neurosurgical units, timely management of the complications of 
subarachnoid haemorrhage and interventions to secure the aneurysm by endovascular coiling 
or surgical clipping at the most appropriate time. The report also highlights the importance of 
providing aSAH patients with comprehensive in-patient and out-patient neurological 
rehabilitation in order to optimise their recovery. 

In responding to the findings of the report the SBNS will lead the development of a National 
Subarachnoid Haemorrhage Care Pathway bringing together the expertise of all specialists 
involved in the care of aSAH patients. The pathway will be based on currently-accepted 
guidelines, consensus statements, published medical evidence and best practice identified by 
the NCEPOD study. The pathway will incorporate standards for patient care to be used by 

The SBNS has been establishing a Neurosurgical National Audit Programme. A national SAH 
audit has been piloted as part of that programme. This will now be developed into a full 
national audit representing all neurosurgical units caring for SAH patients. The standards set 
out in the National SAH Care Pathway will be incorporated into the audit. 

The SBNS will set up a working party jointly with the UK Neuro-Intervention group, Royal 
College of Radiologists and other stakeholders to determine whether extending the current 
national standard of providing aneurysmal intervention within 48 hours to providing 
interventions seven days a week would result in improved outcomes. 

The SBNS is grateful to all of the clinicians who contributed to the initial assessment of patient 
records, to the local NCEPOD co-ordinators, to the expert advisors and the staff of NCEPOD for 
their efforts in completing this important study.



Last Updated: 2 December 2021