de Winkel Jordi, van der Jagt Mathieu, Lingsma Hester F, Roozenbeek Bob, Calvillo Eusebia, Chou Sherry H-Y, Dziedzic Peter H, Etminan Nima, Huang Judy, Ko Nerissa U, Loch MacDonald Robert, Martin Renee L, Potu Niteesh R, Venkatasubba Rao Chethan P, Vergouwen Mervyn D I, Suarez Jose I
Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands.
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands.
J Clin Med. 2021 Feb 14;10(4):762. doi: 10.3390/jcm10040762.
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 < 0.001, and EU vs. other < 0.01) and more often within 24 h (77% and 64% vs. 46%, respectively, US vs. other < 0.001, EU vs. other < 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%, < 0.05) and other centers (81%, < 0.05), and endovascular therapies for cerebral vasospasm are used more often in US centers than in other centers (91% and 60%, respectively, < 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.
先前的研究表明，动脉瘤性蛛网膜下腔出血（aSAH）后功能结局在各中心之间存在显著差异。一种假设是，这些差异是由于实践的变异性所致。为了描述实践的变异性，我们向230个中心发送了一份调查问卷，其中145个中心（63%）进行了回复。参与调查的受访者表示，估计65%的破裂动脉瘤采用血管内治疗。65%的动脉瘤在症状发作后24小时内接受治疗，18%在24 - 48小时内接受治疗，8%在48 - 72小时内接受治疗。美国（US）和欧洲（EU）的中心相比其他中心更常采用血管内治疗动脉瘤（分别为72%和70%，而其他地区为51%，美国与其他地区相比P<0.001，欧盟与其他地区相比P<0.01），且更常在24小时内进行治疗（分别为77%和64%，而其他地区为46%，美国与其他地区相比P<0.001，欧盟与其他地区相比P<0.01）。大多数中心通过给予静脉输液使净液体平衡为0（53%）或+500毫升/天（41%）来实现血容量正常（96%）。美国中心比欧盟（87%，P<0.05）和其他中心（81%，P<0.05）更常使用诱导性高血压，并且美国中心比其他中心更常使用脑血管痉挛的血管内治疗（分别为91%和60%，P<0.05）。我们观察到全球范围内aSAH治疗存在显著的实践变异性。未来需要进行比较疗效研究，以调查实践差异如何导致功能结局的不同。
