Department of Neurosurgery, Queen's Medical Centre, Nottingham University Hospitals Trust, Nottingham, NG7 2UH, UK.
Department of Clinical Neurosciences, Western General Hospital, Edinburgh, EH4 2XU, UK.
Acta Neurochir (Wien). 2019 Feb;161(2):385-392. doi: 10.1007/s00701-018-3765-8. Epub 2019 Jan 12.
Delayed cerebral ischemia (DCI) is an independent predictor of an unfavorable outcome after aneurysmal subarachnoid hemorrhage (aSAH). Many centers, but not all, use transcranial Doppler (TCD) to screen for vasospasm to help predict DCI. We used the United Kingdom and Ireland Subarachnoid Haemorrhage (UKISAH) Registry to see if outcomes were better in centers that used TCD to identify vasospasm compared to those that did not.
TCD screening practices were ascertained by national survey in 13 participating centers of the UKISAH. The routine use of TCD was reported by 5 "screening" centers, leaving 7 "non-screening" centers. Using a cross-sectional cohort study design, prospectively collected data from the UKISAH Registry was used to compare DCI diagnosis and favorable outcome (Glasgow Outcome Score 4 or 5) at discharge based on reported screening practice.
A cohort of 2028 aSAH patients treated ≤ 3 days of hemorrhage was analyzed. DCI was diagnosed in 239/1065 (22.4%) and 220/963 (22.8%) of patients in non-screening and screening centers respectively while 847/1065 (79.5%) and 648/963 (67.2%) achieved a favorable outcome. Odds ratios adjusted for age, injury severity, comorbidities, need for cerebrospinal fluid diversion, and re-bleed returned neutral odds of diagnosing DCI of 0.90 (95% CI 0.72-1.12; p value = 0.347) in screening units compared to those of non-screening units but significantly decreased odds of achieving a favorable outcome 0.56 (95% CI 0.42-0.82; p value < 0.001).
Centers that screened for vasospasm using TCD had poorer in-hospital outcomes and similar rates of DCI diagnosis compared to centers that did not.
迟发性脑缺血（DCI）是蛛网膜下腔出血（aSAH）后不良预后的独立预测因素。许多中心（但并非全部）使用经颅多普勒（TCD）筛查血管痉挛，以帮助预测 DCI。我们使用英国和爱尔兰蛛网膜下腔出血登记处（UKISAH），观察使用 TCD 识别血管痉挛的中心与未使用 TCD 的中心相比，结局是否更好。
通过对 UKISAH 的 13 个参与中心进行全国性调查，确定 TCD 筛查的实践情况。5 个“筛查”中心报告了 TCD 的常规使用，7 个“非筛查”中心未报告。使用横断面队列研究设计，使用 UKISAH 登记处前瞻性收集的数据，根据报告的筛查实践，比较 DCI 诊断和出院时的良好结局（格拉斯哥结局评分 4 或 5）。
分析了 2028 例接受出血后≤3 天治疗的 aSAH 患者。非筛查组和筛查组中，DCI 的诊断率分别为 239/1065（22.4%）和 220/963（22.8%），而 847/1065（79.5%）和 648/963（67.2%）患者获得良好结局。调整年龄、损伤严重程度、合并症、脑脊液引流需求和再出血等因素后，筛查组诊断 DCI 的比值比为 0.90（95%CI 0.72-1.12；p 值=0.347），与非筛查组相比无显著差异，但显著降低了获得良好结局的可能性，比值比为 0.56（95%CI 0.42-0.82；p 值<0.001）。
与未进行 TCD 筛查的中心相比，使用 TCD 筛查血管痉挛的中心住院结局较差，且 DCI 诊断率相似。
