International Practice Variability in Treatment of Aneurysmal Subarachnoid Hemorrhage
Prior research suggests substantial between-center differences in functional outcome following aneurysmal subarachnoid hemorrhage (aSAH). One hypothesis is that these differences are due to practice variability. To characterize practice variability, we sent a survey to 230 centers, of which 145 (63%...
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| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
14 February 2021
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| In: |
Journal of Clinical Medicine
Year: 2021, Volume: 10, Issue: 4, Pages: 1-14 |
| ISSN: | 2077-0383 |
| DOI: | 10.3390/jcm10040762 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.3390/jcm10040762 Verlag, lizenzpflichtig, Volltext: https://www.mdpi.com/2077-0383/10/4/762 
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| Author Notes: | Jordi de Winkel, Mathieu van der Jagt, Hester F. Lingsma, Bob Roozenbeek, Eusebia Calvillo, Sherry H.-Y. Chou, Peter H. Dziedzic, Nima Etminan, Judy Huang, Nerissa U. Ko, Robert Loch MacDonald, Renee L. Martin, Niteesh R. Potu, Chethan P. Venkatasubba Rao, Mervyn D.I. Vergouwen, Jose I. Suarez |
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| 520 | |a Prior research suggests substantial between-center differences in functional outcome following aneurysmal subarachnoid hemorrhage (aSAH). One hypothesis is that these differences are due to practice variability. To characterize practice variability, we sent a survey to 230 centers, of which 145 (63%) responded. Survey respondents indicated that an estimated 65% of ruptured aneurysms were treated endovascularly. Sixty-five percent of aneurysms were treated within 24 h of symptom onset, 18% within 24-48 h, and eight percent within 48-72 h. Centers in the United States (US) and Europe (EU) treat aneurysms more often endovascularly (72% and 70% vs. 51%, respectively, US vs. other p < 0.001, and EU vs. other p < 0.01) and more often within 24 h (77% and 64% vs. 46%, respectively, US vs. other p < 0.001, EU vs. other p < 0.01) compared to other centers. Most centers aim for euvolemia (96%) by administrating intravenous fluids to 0 (53%) or +500 mL/day (41%) net fluid balance. Induced hypertension is more often used in US centers (100%) than in EU (87%, p < 0.05) and other centers (81%, p < 0.05), and endovascular therapies for cerebral vasospasm are used more often in US centers than in other centers (91% and 60%, respectively, p < 0.05). We observed significant practice variability in aSAH treatment worldwide. Future comparative effectiveness research studies are needed to investigate how practice variation leads to differences in functional outcome. | ||
| 650 | 4 | |a aneurysm treatment | |
| 650 | 4 | |a delayed cerebral ischemia | |
| 650 | 4 | |a fluid management | |
| 650 | 4 | |a outcome | |
| 650 | 4 | |a practice variation | |
| 650 | 4 | |a subarachnoid hemorrhage | |
| 650 | 4 | |a vasospasm | |
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