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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Published in:Journal of clinical medicine Vol. 10; no. 4; p. 762
Main Authors: de Winkel, Jordi, van der Jagt, Mathieu, Lingsma, Hester F., Roozenbeek, Bob, Calvillo, Eusebia, Chou, Sherry H-Y., Dziedzic, Peter H., Etminan, Nima, Huang, Judy, Ko, Nerissa U., Loch MacDonald, Robert, Martin, Renee L., Potu, Niteesh R., Venkatasubba Rao, Chethan P., Vergouwen, Mervyn D. I., Suarez, Jose I.
Format: Journal Article
Language:English
Published: Switzerland MDPI AG 14.02.2021
MDPI
Subjects:
Aneurysms
Clinical medicine
Hemorrhage
Hypertension
Ischemia
Polls & surveys
Pulmonary arteries
Stroke
United States > US
fluid management
practice variation
subarachnoid hemorrhage
aneurysm treatment
vasospasm
delayed cerebral ischemia
outcome
ISSN:2077-0383, 2077-0383
Online Access:Get full text
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Summary: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.
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ISSN:2077-0383
2077-0383
DOI:10.3390/jcm10040762