Lagares A, de Toledo P, Fernández-Alén J A, Ibáñez J, Arikan F, Sarabia R, Ballenilla F, Gabarros A, Horcajadas A, Rodríguez-Boto G, de la Lama A, Maillo A, Delgado P, Yacer J L, Domínguez J, Arrese I
Hospital 12 de Octubre, Madrid.
Neurocirugia (Astur). 2008 Oct;19(5):405-15.
Subarachnoid haemorrhage is one of the most severe neurosurgical diseases. Its study is crucial for improving the care of these patients in our environment. With this goal the Group for the Study of Neurovascular Pathology of the Spanish Society for Neurosurgery (SENEC) decided to create a multicenter registry for the study of this disease.
In this database we have prospectively included all cases with spontaneous subarachnoid haemorrhage admitted to the participant hospitals from November 2004 to November 2007. The fields to be included in the database were selected by consensus, including age, past medical history, clinical characteristics at admission, radiological characteristics including presence or absence of an aneurysm and its size and location, type and complications of the aneurysm treatment, outcome assessed by the Glasgow Outcome Scale (GOS) at discharge and six months after the bleeding as well as the angiographic result of the aneurysm treatment. All fields were collected by means of an electronic form posted in secure web page.
During the three years of study a total of 1149 patients have been included by 14 Hospitals. The time needed to fill in a patient in the registry is approximately 3.4 minutes. This series of patients with spontaneous SAH is similar to other non-selected in-hospital series of SAH. The mean age of the patients is 55 years and there is a 4:3 female to male ratio. In relation to the severity of the bleeding 32% of the patients were in poor clinical grade at admission (WFNS 4 or 5). 5% of the patients died before angiography could be performed. An aneurysm was confirmed as the origin of the bleeding in 76% of the patients (aSAH), while in 19% of the patients no lesion was found in the angiographic studies and were thus classified as idiopathic subarachnoid hemorrhage (ISAH). Of those patients with aSAH, 47% were treated endovascularly, 39% surgically, 3% received a combined treatment and 11% did not receive any treatment for their aneurysm because of early death. Regarding outcome, there is a 22% mortality in the series. Only 40% of the patients with aSAH reached a good outcome at discharge (GOS = 5).
Spontaneous SAH continues to be a disease with high morbidity and mortality. This database can be an ideal instrument for improving the knowledge about this disease in our environment and to achieve better results. It would be desirable that this database could in the future be the origin of a national registry of spontaneous SAH.
蛛网膜下腔出血是最严重的神经外科疾病之一。对其进行研究对于改善我们环境中此类患者的护理至关重要。出于这一目的，西班牙神经外科学会（SENEC）神经血管病理学研究小组决定创建一个多中心登记处来研究这种疾病。
在这个数据库中，我们前瞻性地纳入了2004年11月至2007年11月期间入住参与医院的所有自发性蛛网膜下腔出血病例。数据库中要纳入的字段通过共识选定，包括年龄、既往病史、入院时的临床特征、放射学特征（包括是否存在动脉瘤及其大小和位置）、动脉瘤治疗的类型和并发症、出院时以及出血后六个月根据格拉斯哥预后量表（GOS）评估的结果以及动脉瘤治疗的血管造影结果。所有字段均通过发布在安全网页上的电子表格收集。
在三年的研究期间，14家医院共纳入了1149例患者。在登记处录入一名患者所需的时间约为3.4分钟。这一系列自发性蛛网膜下腔出血患者与其他未经过挑选的医院内蛛网膜下腔出血系列患者相似。患者的平均年龄为55岁，女性与男性的比例为4:3。关于出血的严重程度，32%的患者入院时临床分级较差（世界神经外科联盟分级4或5级）。5%的患者在能够进行血管造影之前死亡。76%的患者（动脉瘤性蛛网膜下腔出血）出血的起源被确认为动脉瘤，而在19%的患者中，血管造影研究未发现病变，因此被归类为特发性蛛网膜下腔出血（ISAH）。在那些动脉瘤性蛛网膜下腔出血患者中，47%接受了血管内治疗，39%接受了手术治疗，3%接受了联合治疗，11%由于早期死亡未接受任何动脉瘤治疗。关于预后，该系列的死亡率为22%。只有40%的动脉瘤性蛛网膜下腔出血患者出院时达到良好预后（GOS = 5）。
自发性蛛网膜下腔出血仍然是一种发病率和死亡率都很高的疾病。这个数据库可以成为提高我们环境中对这种疾病的认识并取得更好结果的理想工具。希望这个数据库将来能够成为全国自发性蛛网膜下腔出血登记处的基础。
