# Epidemiology of Patients Coming With Subarachnoid Hemorrhage to a Tertiary Care Facility in the State of Qatar

## TL;DR

This study analyzes subarachnoid hemorrhage cases in Qatar, showing younger age, male dominance, and better outcomes with coiling treatment.

## Contribution

Provides a population-level epidemiological profile of SAH in Qatar with treatment outcome comparisons.

## Key findings

- 80% of SAH cases were aneurysmal, with males comprising 62.4% of patients and an average age of 45.2 years.
- Endovascular coiling was associated with better functional outcomes compared to clipping, especially in posterior circulation aneurysms.
- Functional outcomes were strongly influenced by neurological severity and hemorrhage burden at presentation.

## Abstract

Introduction: We aim to provide an up-to-date, near population-level portrait of spontaneous subarachnoid hemorrhage in Qatar, where a centralized neurosurgical service and a young, male-predominant expatriate workforce create a distinct epidemiologic profile.

Objective: To provide an updated, near population-level description of spontaneous, non-traumatic subarachnoid hemorrhage presenting to the national tertiary neurosurgical referral center in Qatar from January 2017 to January 2025, including demographics, aneurysmal versus non-aneurysmal proportions, vascular risk factors, management patterns, and functional outcomes.

Method: We conducted a single-center retrospective cohort study at Hamad General Hospital, including consecutive patients aged ≥15 years admitted from January 2017 to January 2025 with non-traumatic SAH confirmed on non-contrast CT. Aneurysmal status was determined by CT angiography or digital subtraction angiography; patients with complete negative vascular imaging were classified as non-aneurysmal SAH. Demographic, clinical, and radiological variables, treatment modality (clipping, coiling), and timing of external ventricular drain placement were abstracted from charts and the Cerner record. The primary outcome was modified Rankin Scale at discharge and follow-up, categorized as good (0-1), moderate (2-3), or poor/fatal (4-6). Associations were analyzed using Spearman correlation, χ² tests, logistic modelling, and propensity score matching for age, World Federation of Neurosurgical Societies (WFNS) grade, and comorbidities, under IRB approval with consent waived.

Result: Of 561 SAH patients, 449 (80%) were aneurysmal; 350 (62.4%) were male; the mean age was 45.2±12.8 years. The cohort was multiethnic (South Asian 239(42.6%), Middle Eastern 159 (28.3%), Southeast Asian 102(18.2%). Comorbidities included hypertension 209 (37.2%), smoking 177 (31.5%), and diabetes 72 (12.8%). Functional outcomes were good in 240 (42.8%), moderate in 194 (34.6%), and poor/fatal in 127 (22.6%). Prognosis correlated strongly with neurological severity and hemorrhage burden: WFNS (ρ=0.62, p<0.001), Fisher score (ρ=0.41, p<0.001), and inversely with GCS (ρ=−0.58, p<0.001); each 1-point decrease in GCS increased odds of poor outcome by 58% (OR 1.58, 95% CI 1.42-1.76). Early EVD placement was associated with better function versus later placement (median Mrs 1.9 vs 3.4, p<0.001). Coiling yielded superior unadjusted outcomes to clipping (median Mrs 1 vs 2, p=0.037) and remained associated with higher odds of good outcome after matching (OR 1.38, 95% CI 1.02-1.87, p=0.03). Territory-specific effects were observed: posterior-circulation aneurysms benefited from coiling (OR for poor outcome 0.51, 95% CI 0.32-0.81, p=0.004), while anterior-circulation lesions more often favored clipping for good outcome (p=0.04).

Conclusion: In a large state-of-the-art, tertiary care hospital serving a young, male-skewed population, SAH presents at a younger age with a distinct ethnic composition, yet the principal determinants of outcome remain neurological grade and hemorrhage burden at presentation. Endovascular coiling is associated with better functional outcomes overall, particularly in the posterior circulation, while clipping retains a role for selected anterior circulation aneurysms. These findings offer current evidence base for service planning, targeted prevention in high-risk subpopulations, and the design of prospective trials in the region.