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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%...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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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. |
format | Online Article Text |
id | pubmed-7917699 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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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