Case fatality and functional outcome after spontaneous subarachnoid haemorrhage: a systematic review and meta-analysis of time trends and regional variations in population-based studies
Introduction: A previous systematic review of population-based studies from 1973 to 2002 found a decrease in case fatality for spontaneous subarachnoid haemorrhage, but could not find a sufficient number of studies to assess changes in functional outcome. Since then, treatment has advanced distinctl...
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| Main Authors: | , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
February 14, 2024
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| In: |
European stroke journal
Year: 2024, Volume: 9, Issue: 3, Pages: 555-565 |
| ISSN: | 2396-9881 |
| DOI: | 10.1177/23969873241232823 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1177/23969873241232823
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| Author Notes: | Andreas Ziebart, Judith Dremel, Svetlana Hetjens, Dennis J Nieuwkamp, Francisca HH Linn, Nima Etminan, and Gabriel JE Rinkel |
| Summary: | Introduction: A previous systematic review of population-based studies from 1973 to 2002 found a decrease in case fatality for spontaneous subarachnoid haemorrhage, but could not find a sufficient number of studies to assess changes in functional outcome. Since then, treatment has advanced distinctly. We assessed whether case fatality has decreased further and whether functional outcome has improved. - Patients and methods: We searched PubMed and Web of Science for new population-based studies using the same criteria as in our previous systematic review. We assessed changes in case fatality and functional outcome over time using linear regression. - Results: We included 24 new studies with 827 patients and analysed 9542 patients described in 62 study periods between 1973 and 2017. Case fatality decreased by 0.3% (95% CI: −0.7 to 0.1) per year. In a sensitivity analysis excluding studies that did not provide 1-month outcome and outliers, the age and sex-adjusted decrease was 0.1% per year (95% CI: −0.9 to 0.6). The mean case fatality rate decreased from 47% (95% CI: 31-63) in the 1970s to 35% (95% CI: 30-39) in the 1990s, and remained stable in the 2000s (34%; 95% CI: 27-41) and 2010s (38%; 95% CI: 15-60). In 15 studies, the mean proportion of patients living independently increased by 0.2% per year (95%CI: −0.7 to 1.1) and the mean was 45% (95% CI: 39-50) in six studies that reported outcome after 12 months. - Discussion and conclusion: From 1973 to 2017, the case-fatality rate of spontaneous subarachnoid haemorrhage declined overall by 13.5%, but remained stable over the last two decades. The data on time trends in functional outcome were inconclusive. |
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| Item Description: | Gesehen am 09.09.2024 |
| Physical Description: | Online Resource |
| ISSN: | 2396-9881 |
| DOI: | 10.1177/23969873241232823 |