1376 A Retrospective Analysis of the Effect of Methamphetamine Usage on Vasospasm and Outcomes Following Angiogram-Negative Subarachnoid Hemorrhage

INTRODUCTION: Angiogram-negative subarachnoid hemorrhage (ANSAH) has a variable clinical course. Methamphetamine abuse is a growing public health crisis yet its influence on ANSAH outcomes has not been examined. METHODS: An 11-year retrospective cohort analysis was performed among consecutive patients presenting to our institution with ANSAH. Methamphetamine positivity (MP) was defined as presence of methamphetamine on urine toxicology and/or by patient report. Primary outcomes were evaluated with multivariate analysis and examined radiographic vasospasm, clinical vasospasm, and discharge home. RESULTS: 101 patients met inclusion criteria and had an average age of 59.7±1.2 years and median Hunt and Hess score of 2. Eight (7.9%) patients were MP and were younger (47.5±3.3 v. 60.8±1.2 years, p=0.004) than methamphetamine negative (MN) patients. There were no other significant differences in demographic between both groups. In univariate analysis, MP patients were nearly 12x more likely to have radiographic vasospasm (OR 11.6; 95%:1.4-98.3, p=0.008) but no significant difference in clinical vasospasm (p=0.233) and discharge home (p=0.678). One MP patient died and none had a repeat SAH or found to have an underlying aneurysm. MP patients were more likely to require hypertonic saline (OR 8.50; 95%CI:1.01-71.9, p=0.028) but no significant difference in need for intra-arterial verapamil (p=0.511), stroke (p=0.233), days of nicardipine (p=0.879), complications (p=0.245), or ICU (p=0.756) or hospital (p=0.945) length of stay. In multivariate analysis, MP was independently associated with increased radiographic vasospasm (p=0.017) but not clinical vasospasm (p=0.063) or discharge location (p=0.843). CONCLUSIONS: ANSAH patients with recent methamphetamine use have an increased odds of radiographic vasospasm but no difference in clinical outcomes compared to MN patients. This study adds to our understanding of the clinical course of MP ANSAH patients and can be valuable for patient education.