International Practice Variability in Treatment of Aneurysmal Subarachnoid Hemorrhage

Autor:	Jose I. Suarez, Niteesh R Potu, Peter H Dziedzic, Mathieu van der Jagt, Renee L. Martin, Mervyn D.I. Vergouwen, Nerissa U. Ko, Bob Roozenbeek, Jordi de Winkel, Hester F. Lingsma, Chethan P. Venkatasubba Rao, R. L. Macdonald, Eusebia Calvillo, Judy Huang, Nima Etminan, Sherry H.-Y. Chou
Přispěvatelé:	Neurology, Public Health, Intensive Care
Rok vydání:	2021
Předmět:	medicine.medical_specialty Subarachnoid hemorrhage subarachnoid hemorrhage Ruptured aneurysms aneurysm treatment lcsh:Medicine Fluid management 030204 cardiovascular system & hematology Article 03 medical and health sciences 0302 clinical medicine Cerebral vasospasm Aneurysm treatment Internal medicine medicine cardiovascular diseases Symptom onset vasospasm business.industry lcsh:R Vasospasm General Medicine medicine.disease fluid management cardiovascular system outcome delayed cerebral ischemia business 030217 neurology & neurosurgery practice variation
Zdroj:	Journal of Clinical Medicine, Vol 10, Iss 762, p 762 (2021) Journal of Clinical Medicine Volume 10 Issue 4 Journal of Clinical Medicine, 10(4):762, 1-14. Multidisciplinary Digital Publishing Institute (MDPI)
ISSN:	2077-0383
DOI:	10.3390/jcm10040762
Popis:	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.
Databáze:	OpenAIRE
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