Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario, Canada.
Can J Neurol Sci. 2012 Sep;39(5):638-43. doi: 10.1017/s0317167100015389.
Previously all subarachnoid hemorrhage (SAH) patients were admitted, whereas now patients with angiography may be discharged.
To survey neurosurgeons to determine current practice and what constitutes a clinically significant subarachnoid hemorrhage.
We surveyed all neurosurgeons listed in the Canadian Medical Directory. We used a modified Dillman technique with up to five mailed surveys plus a pre-notification letter. Neurosurgeons rated the significance of 13 scenarios of subarachnoid hemorrhage. Scenarios varied from aneurysmal subarachnoid hemorrhage to patients with isolated xanthochromia in cerebrospinal fluid. Each scenario was rated for clinical significance using a 5-point scale [1(always) to 5(never)].
Of the 224 surveyed, 115 neurosurgeons responded. Scenarios with aneurysms requiring intervention, arteriovenous malformations, death or any surgical intervention all had median responses of 1 (IQR 1, 1). Scenarios having xanthochromia and few red blood cells in cerebrospinal fluid with negative computerized tomogram (CT) and angiography had median responses of 3 (IQR 1, 4). Scenarios with perimesencephalic pattern on CT with negative angiography had median of 3 (IQR 2, 4). Scenarios where patient is discharged from the emergency department had median of 4 (IQR 3, 5).
Subarachnoid hemorrhages due to aneurysms or arteriovenous malformations causing death or requiring surgical intervention are always clinically significant. Other types of nonaneurysmal subarachnoid hemorrhages had inconsistent ratings for clinical significance. These survey results highlight the need for further discussions to standardize the diagnosis of what constitutes a clinically significant subarachnoid hemorrhage and what care should be afforded to these patients.
之前所有蛛网膜下腔出血（SAH）患者都需要住院治疗，而现在有血管造影的患者可以出院。
调查神经外科医生，以确定当前的实践和什么构成临床上显著的蛛网膜下腔出血。
我们调查了加拿大医学名录中的所有神经外科医生。我们使用了一种经过修改的迪尔曼（Dillman）技术，最多进行了五次邮寄调查，并附有预通知信。神经外科医生对 13 种蛛网膜下腔出血情况进行了评分。这些情况从动脉瘤性蛛网膜下腔出血到仅有脑脊液黄变症的患者不等。每个情况都使用 5 分制（1（总是）到 5（从不））进行临床意义评分。
在接受调查的 224 名神经外科医生中，有 115 名做出了回应。需要干预的动脉瘤、动静脉畸形、死亡或任何手术干预的情况，中位数为 1（IQR 1, 1）。有黄变症和脑脊液中红细胞较少，计算机断层扫描（CT）和血管造影均为阴性的情况，中位数为 3（IQR 1, 4）。CT 显示为中脑周围模式且血管造影阴性的情况，中位数为 3（IQR 2, 4）。从急诊室出院的患者的情况，中位数为 4（IQR 3, 5）。
由于动脉瘤或动静脉畸形导致死亡或需要手术干预的蛛网膜下腔出血总是具有临床意义的。其他类型的非动脉瘤性蛛网膜下腔出血对临床意义的评分不一致。这些调查结果突出表明，需要进一步讨论，以标准化什么构成临床上显著的蛛网膜下腔出血的诊断，以及应该为这些患者提供什么样的护理。
