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Observational Study
. 2016 Nov 22;87(21):2192-2197.
doi: 10.1212/WNL.0000000000003353. Epub 2016 Oct 21.

Stable incidence but declining case-fatality rates of subarachnoid hemorrhage in a population

Jason Mackey  1 , Jane C Khoury  2 , Kathleen Alwell  2 , Charles J Moomaw  2 , Brett M Kissela  2 , Matthew L Flaherty  2 , Opeolu Adeoye  2 , Daniel Woo  2 , Simona Ferioli  2 , Felipe De Los Rios La Rosa  2 , Sharyl Martini  2 , Pooja Khatri  2 , Joseph P Broderick  2 , Mario Zuccarello  2 , Dawn Kleindorfer  2
Affiliations
Observational Study

Stable incidence but declining case-fatality rates of subarachnoid hemorrhage in a population

Jason Mackey et al. Neurology. .

Abstract

Objective: To characterize temporal trends in subarachnoid hemorrhage (SAH) incidence and outcomes over 5 time periods in a large population-based stroke study in the United States.

Methods: All SAHs among residents of the Greater Cincinnati/Northern Kentucky region at least 20 years of age were identified and verified via study physician review in 5 distinct year-long study periods between 1988 and 2010. We abstracted demographics, care patterns, and outcomes, and we compared incidence and case-fatality rates across the study periods.

Results: The incidence of SAH in the 5 study periods (age-, race-, and sex-adjusted to the 2000 US population) was 8.8 (95% confidence interval 6.8-10.7), 9.2 (7.2-11.2), 10.0 (8.0-12.0), 9.0 (7.1-10.9), and 7.7 (6.0-9.4) per 100,000, respectively; the trend in incidence rates from 1988 to 2010 was not statistically significant (p = 0.22). Advanced neurovascular imaging, endovascular coiling, and neurologic intensive care unit availability increased significantly over time. All-cause 5-day (32%-18%, p = 0.01; for trend), 30-day (46%-25%, p = 0.001), and 90-day (49%-29%, p = 0.001) case-fatality rates declined from 1988 to 2010. When we included only proven or highly likely aneurysmal SAH, the declines in case-fatality were no longer statistically significant.

Conclusions: Although the incidence of SAH remained stable in this population-based region, 5-day, 30-day, and 90-day case-fatality rates declined significantly. Advances in surgical and medical management, along with systems-based changes such as the emergence of neurocritical care units, are potential explanations for the reduced case-fatality.

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Figures

Figure
Figure. Short-term subarachnoid hemorrhage (SAH) outcomes over time
See this image and copyright information in PMC

References

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