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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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Autores principales: 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.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7917699/
https://www.ncbi.nlm.nih.gov/pubmed/33672807
http://dx.doi.org/10.3390/jcm10040762
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author 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.
author_facet 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.
author_sort de Winkel, Jordi
collection PubMed
description 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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spelling pubmed-79176992021-03-02 International Practice Variability in Treatment of Aneurysmal Subarachnoid Hemorrhage 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. J Clin Med Article 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. MDPI 2021-02-14 /pmc/articles/PMC7917699/ /pubmed/33672807 http://dx.doi.org/10.3390/jcm10040762 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
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.
International Practice Variability in Treatment of Aneurysmal Subarachnoid Hemorrhage
title International Practice Variability in Treatment of Aneurysmal Subarachnoid Hemorrhage
title_full International Practice Variability in Treatment of Aneurysmal Subarachnoid Hemorrhage
title_fullStr International Practice Variability in Treatment of Aneurysmal Subarachnoid Hemorrhage
title_full_unstemmed International Practice Variability in Treatment of Aneurysmal Subarachnoid Hemorrhage
title_short International Practice Variability in Treatment of Aneurysmal Subarachnoid Hemorrhage
title_sort international practice variability in treatment of aneurysmal subarachnoid hemorrhage
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7917699/
https://www.ncbi.nlm.nih.gov/pubmed/33672807
http://dx.doi.org/10.3390/jcm10040762
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