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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Vydané v:	Journal of clinical medicine Ročník 10; číslo 4; s. 762
Hlavní autori:	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.
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	Switzerland MDPI AG 14.02.2021 MDPI
Predmet:	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
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Abstract	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.
AbstractList	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. 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 < 0.001, and EU vs. other < 0.01) and more often within 24 h (77% and 64% vs. 46%, respectively, US vs. other < 0.001, EU vs. other < 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%, < 0.05) and other centers (81%, < 0.05), and endovascular therapies for cerebral vasospasm are used more often in US centers than in other centers (91% and 60%, respectively, < 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. 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.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.
Author	Etminan, Nima Dziedzic, Peter H. Roozenbeek, Bob Potu, Niteesh R. Ko, Nerissa U. Loch MacDonald, Robert Venkatasubba Rao, Chethan P. Vergouwen, Mervyn D. I. Chou, Sherry H-Y. Martin, Renee L. Suarez, Jose I. Huang, Judy van der Jagt, Mathieu Lingsma, Hester F. de Winkel, Jordi Calvillo, Eusebia
AuthorAffiliation	4 Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; ecalvil2@jhmi.edu (E.C.); phd@jhu.edu (P.H.D.); npotu1@jhmi.edu (N.R.P.) 1 Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; j.dewinkel@erasmusmc.nl (J.d.W.); b.roozenbeek@erasmusmc.nl (B.R.) 6 Department of Neurosurgery, University of Heidelberg School of Medicine, 69117 Mannheim, Germany; nima.etminan@medma.uni-heidelberg.de 5 Departments of Critical Care Medicine, Neurology, and Neurosurgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA; hsc36@pitt.edu 12 Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands; m.d.i.vergouwen@umcutrecht.nl 3 Department of Intensive Care Adults, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; m.vanderjagt@erasmusmc.nl 13 Division of Ne
AuthorAffiliation_xml	– name: 6 Department of Neurosurgery, University of Heidelberg School of Medicine, 69117 Mannheim, Germany; nima.etminan@medma.uni-heidelberg.de – name: 1 Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; j.dewinkel@erasmusmc.nl (J.d.W.); b.roozenbeek@erasmusmc.nl (B.R.) – name: 12 Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands; m.d.i.vergouwen@umcutrecht.nl – name: 5 Departments of Critical Care Medicine, Neurology, and Neurosurgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA; hsc36@pitt.edu – name: 11 Departments of Neurology, Neurosurgery, and Center for Space medicine, Baylor College of Medicine, Houston, TX 77030, USA; cprao@bcm.edu – name: 13 Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA – name: 10 Department of Biostatistics and Epidemiology, Medical University of South Carolina, Charleston, SC 29425, USA; hebertrl@musc.edu – name: 7 Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; jhuang24@jhmi.edu – name: 4 Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; ecalvil2@jhmi.edu (E.C.); phd@jhu.edu (P.H.D.); npotu1@jhmi.edu (N.R.P.) – name: 9 UCSF Fresno Department of Neurosurgery, UCSF School of Medicine, University Neuroscience Institute, Fresno, CA 93701, USA; rlochmacdonald@gmail.com – name: 2 Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; h.lingsma@erasmusmc.nl – name: 3 Department of Intensive Care Adults, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; m.vanderjagt@erasmusmc.nl – name: 8 Department of Neurology, UCSF Weill Institute for Neurosciences, UCSF School of Medicine, San Francisco, CA 94143, USA; nerissa.ko@ucsf.edu
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Keywords	fluid management practice variation subarachnoid hemorrhage aneurysm treatment vasospasm delayed cerebral ischemia outcome
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Snippet	Prior research suggests substantial between-center differences in functional outcome following aneurysmal subarachnoid hemorrhage (aSAH). One hypothesis is...
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SubjectTerms	Aneurysms Clinical medicine Hemorrhage Hypertension Ischemia Polls & surveys Pulmonary arteries Stroke
Title	International Practice Variability in Treatment of Aneurysmal Subarachnoid Hemorrhage
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