University Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK.
Neurology. 2010 May 11;74(19):1494-501. doi: 10.1212/WNL.0b013e3181dd42b3. Epub 2010 Apr 7.
Treatment of aneurysmal subarachnoid hemorrhage (SAH) has changed substantially over the last 25 years but there is a lack of reliable population-based data on whether case-fatality or functional outcomes have improved.
We determined changes in the standardized incidence and outcome of SAH in the same population between 1981 and 1986 (Oxford Community Stroke Project) and 2002 and 2008 (Oxford Vascular Study). In a meta-analysis with other population-based studies, we used linear regression to determine time trends in outcome.
There were no reductions in incidence of SAH (RR = 0.79, 95% confidence interval [CI] 0.48-1.29, p = 0.34) and in 30-day case-fatality (RR = 0.67, 95% CI 0.39-1.13, p = 0.14) in the Oxford Vascular Study vs Oxford Community Stroke Project, but there was a decrease in overall mortality (RR = 0.47, 0.23-0.97, p = 0.04). Following adjustment for age and baseline SAH severity, patients surviving to hospital had reduced risk of death or dependency (modified Rankin score > 3) at 12 months in the Oxford Vascular Study (RR = 0.51, 0.29-0.88, p = 0.01). Among 32 studies covering 39 study periods from 1980 to 2005, 7 studied time trends within single populations. Unadjusted case-fatality fell by 0.9% per annum (0.3-1.5, p = 0.007) in a meta-analysis of data from all studies, and by 0.9% per annum (0.2-1.6%, p = 0.01) within the 7 population studies.
Mortality due to subarachnoid hemorrhage fell by about 50% in our study population over the last 2 decades, due mainly to improved outcomes in cases surviving to reach hospital. This improvement is consistent with a significant decrease in case-fatality over the last 25 years in our pooled analysis of other similar population-based studies.
在过去的 25 年中，对颅内动脉瘤性蛛网膜下腔出血（SAH）的治疗发生了重大变化，但缺乏关于病死率或功能预后是否改善的可靠人群数据。
我们在 1981 年至 1986 年（牛津社区卒中项目）和 2002 年至 2008 年（牛津血管研究）的同一人群中确定了 SAH 的标准化发病率和结局的变化。在一项与其他人群研究的荟萃分析中，我们使用线性回归来确定结局的时间趋势。
在牛津血管研究中，SAH 的发病率（RR=0.79，95%置信区间[CI]0.48-1.29，p=0.34）和 30 天病死率（RR=0.67，95%CI0.39-1.13，p=0.14）均未降低，但总体死亡率降低（RR=0.47，0.23-0.97，p=0.04）。在校正年龄和基线 SAH 严重程度后，在牛津血管研究中，存活至出院的患者在 12 个月时死亡或依赖（改良 Rankin 评分>3）的风险降低（RR=0.51，0.29-0.88，p=0.01）。在 1980 年至 2005 年的 32 项研究涵盖 39 个研究期间的 32 项研究中，有 7 项研究了单个人群内的时间趋势。在所有研究的数据的荟萃分析中，未调整的病死率每年下降 0.9%（0.3-1.5，p=0.007），在 7 项人群研究中每年下降 0.9%（0.2-1.6%，p=0.01）。
在过去的 20 年中，我们研究人群中蛛网膜下腔出血导致的死亡率下降了约 50%，这主要是由于存活至到达医院的患者的结局改善。在我们对其他类似人群研究的汇总分析中，病死率在过去 25 年中显著下降，这与我们的研究结果一致。
