Time trends in the risk of delayed cerebral ischemia after subarachnoid hemorrhage: a meta-analysis of randomized controlled trials.

Autor:	Rigante L; 1Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands., van Lieshout JH; 2Department of Neurosurgery, Henrich-Heine-University Düsseldorf, Germany., Vergouwen MDI; 3Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands., van Griensven CHS; 4Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands., Vart P; 5Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands., van der Loo L; 6Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands., de Vries J; 1Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands., Vinke RS; 1Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands., Etminan N; 7Department of Neurosurgery, Universitätsmedizin Mannheim, Germany., Aquarius R; 1Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands., Gruber A; 8Department of Neurosurgery, Kepler University Hospital, Linz, Austria., Mocco J; 9Department of Neurosurgery, Mount Sinai Health System, New York, New York., Welch BG; 10Department of Neurosurgery, University of Texas Southwestern, Dallas, Texas., Menovsky T; 11Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium., Klijn CJM; 12Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands; and., Bartels RHMA; 1Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands., Germans MR; 13Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, Zurich, Switzerland., Hänggi D; 2Department of Neurosurgery, Henrich-Heine-University Düsseldorf, Germany., Boogaarts HD; 1Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
Jazyk:	angličtina
Zdroj:	Neurosurgical focus [Neurosurg Focus] 2022 Mar; Vol. 52 (3), pp. E2.
DOI:	10.3171/2021.12.FOCUS21473
Abstrakt:	Objective: Delayed cerebral ischemia (DCI) contributes to morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). Continuous improvement in the management of these patients, such as neurocritical care and aneurysm repair, may decrease the prevalence of DCI. In this study, the authors aimed to investigate potential time trends in the prevalence of DCI in clinical studies of DCI within the last 20 years. Methods: PubMed, Embase, and the Cochrane library were searched from 2000 to 2020. Randomized controlled trials that reported clinical (and radiological) DCI in patients with aSAH who were randomized to a control group receiving standard care were included. DCI prevalence was estimated by means of random-effects meta-analysis, and subgroup analyses were performed for the DCI sum score, Fisher grade, clinical grade on admission, and aneurysm treatment method. Time trends were evaluated by meta-regression. Results: The search strategy yielded 5931 records, of which 58 randomized controlled trials were included. A total of 4424 patients in the control arm were included. The overall prevalence of DCI was 0.29 (95% CI 0.26-0.32). The event rate for prevalence of DCI among the high-quality studies was 0.30 (95% CI 0.25-0.34) and did not decrease over time (0.25% decline per year; 95% CI -2.49% to 1.99%, p = 0.819). DCI prevalence was higher in studies that included only higher clinical or Fisher grades, and in studies that included only clipping as the treatment modality. Conclusions: Overall DCI prevalence in patients with aSAH was 0.29 (95% CI 0.26-0.32) and did not decrease over time in the control groups of the included randomized controlled trials.
Databáze:	MEDLINE
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