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. 2021 Feb 14;10(4):762.
doi: 10.3390/jcm10040762.

International Practice Variability in Treatment of Aneurysmal Subarachnoid Hemorrhage

Jordi de Winkel  1   2 , Mathieu van der Jagt  3 , Hester F Lingsma  2 , Bob Roozenbeek  1 , Eusebia Calvillo  4 , Sherry H-Y Chou  5 , Peter H Dziedzic  4 , Nima Etminan  6 , Judy Huang  7 , Nerissa U Ko  8 , Robert Loch MacDonald  9 , Renee L Martin  10 , Niteesh R Potu  4 , Chethan P Venkatasubba Rao  11 , Mervyn D I Vergouwen  12 , Jose I Suarez  13
Affiliations

International Practice Variability in Treatment of Aneurysmal Subarachnoid Hemorrhage

Jordi de Winkel et al. J Clin Med. .

Abstract

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.

Keywords: aneurysm treatment; delayed cerebral ischemia; fluid management; outcome; practice variation; subarachnoid hemorrhage; vasospasm.

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Conflict of interest statement

Authors report no conflict of interest.

Figures

Figure 1
Figure 1
Geographical map representing the countries of origin of participating centers.
Figure 2
Figure 2
Type and timing of aneurysm treatment: (A) per center estimated proportion of patients with aneurysmal subarachnoid hemorrhage (aSAH) who have their aneurysm treated by endovascular means, (B) per center estimated proportion of patients with aSAH who have their aneurysm treated within 24 h from symptom onset, (C) per center estimated proportion of patients with aSAH who have their aneurysm treated within 24–48 h from symptom onset, and (D) per center estimated proportion of patients with aSAH who have their aneurysm treated within 48–72 h from symptom onset.
Figure 2
Figure 2
Type and timing of aneurysm treatment: (A) per center estimated proportion of patients with aneurysmal subarachnoid hemorrhage (aSAH) who have their aneurysm treated by endovascular means, (B) per center estimated proportion of patients with aSAH who have their aneurysm treated within 24 h from symptom onset, (C) per center estimated proportion of patients with aSAH who have their aneurysm treated within 24–48 h from symptom onset, and (D) per center estimated proportion of patients with aSAH who have their aneurysm treated within 48–72 h from symptom onset.
Figure 2
Figure 2
Type and timing of aneurysm treatment: (A) per center estimated proportion of patients with aneurysmal subarachnoid hemorrhage (aSAH) who have their aneurysm treated by endovascular means, (B) per center estimated proportion of patients with aSAH who have their aneurysm treated within 24 h from symptom onset, (C) per center estimated proportion of patients with aSAH who have their aneurysm treated within 24–48 h from symptom onset, and (D) per center estimated proportion of patients with aSAH who have their aneurysm treated within 48–72 h from symptom onset.
Figure 3
Figure 3
Management of delayed cerebral ischemia (DCI) in survey respondents’ hospitals.
See this image and copyright information in PMC

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