BACKGROUND: Headache is the most common presenting symptom of subarachnoid 
hemorrhage (SAH), ranging from mild headache to the "worst headache of my life". 
As headache is often non-specific, patients may not seek immediate medical 
attention, though prompt medical and surgical management is expected to improve 
clinical outcomes. In this study, we explore the independent association between 
duration from onset of symptoms to presentation at an emergency department (ED) 
and clinical outcomes after SAH.
METHODS: Participants with a primary diagnosis of nontraumatic SAH were 
identified from consecutive patients at 11 regional stroke centres participating 
in the Registry of the Canadian Stroke Network (RCSN, 2003-2005). Hunt and Hess 
score (H+H), and modified Rankin Scale (mRS) at discharge were collected on SAH 
cases by trained nurse-abstractors. For analysis, patients were categorized into 
patients with mild-moderate dependency (mRS 0-3) and those with severe 
dependence or death (mRS 4-6) at hospital discharge. Multivariable regression 
analyses were used to determine the association between 'time to presentation' 
and clinical outcomes, independent of comorbidities.
RESULTS: Of 721 SAH patients included in the RCSN, 642 (89.0%) had the interval 
between 'time last seen normal' and time of ED presentation recorded. Mean 
duration from symptom onset to ED arrival was 27.04 hours (+/- 2.02). One 
hundred and sixty-six patients (25.9%) presented to the ED more than 24 hours 
after onset of symptoms. On multivariable analysis, there was no association 
between time to presentation and severe disability or death at hospital 
discharge (OR 1.0 [95% CI 0.95-1.01]); 30-day mortality (OR 1.0 [95% CI 
0.91-1.02]; or six-month mortality (OR 1.0 [95% CI 1.0-1.02]). Increasing H+H 
score and age were significantly associated with increased odds of death and 
severe dependence at hospital discharge.
CONCLUSIONS: In this observational study, duration from symptom onset to 
hospital presentation was not independently associated with death or severe 
disability at hospital discharge following SAH. Age and H+H score were 
independent predictors of clinical outcome after non-traumatic SAH.