Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
J Clin Neurosci. 2022 Sep;103:20-25. doi: 10.1016/j.jocn.2022.06.022. Epub 2022 Jul 8.
Our objective was to describe antiseizure medication (ASM) prescription patterns, and associations between ASM use and death and disability outcomes in patients with aneurysmal subarachnoid haemorrhage (aSAH) admitted to ICU. This was a multi-centre prospective observational study. The study took place in eleven ICUs across Australia and New Zealand. Data was collected from 1 April 2017 to 1 October 2018. Three hundred and fifty-seven adult patients with aSAH were enrolled. The primary outcome was to describe patterns of ASM prescription. The secondary outcome of interest was death or disability (modified Rankin Scale (mRS) score ≥ 4) at six months, and its association with ASM therapy, and relevant clinical subgroups. Forty percent of patients received an ASM and the most commonly used agent was levetiracetam. The median length of ASM administration was eight days (IQR 4.5-12.5). A number of patients with prehospital seizures did not receive ASM therapy (14/55, 2725%). There was a tendency towards ASM prescription with both higher radiological and clinical grade aSAH. There was no significant association between death or disability at six month (mRS ≥ 4) and ASM vs No ASM prescription. Testing for an interaction effect between ASM administration and WFNS grade suggested inferior outcomes with ASM use in lower aSAH grades (p = 0.04). In conclusion, the prescription of ASM for aSAH in Australia is variable across and within sites, with the majority of patients not receiving ASM chemoprophylaxis. We demonstrated no significant association between death or disability at six months and the use of ASM. There may be an association with poorer outcomes in patients with lower grade aSAH. This finding requires further exploration.
我们的目的是描述抗癫痫药物（ASM）的处方模式，以及抗癫痫药物在 ICU 收治的颅内动脉瘤性蛛网膜下腔出血（aSAH）患者中的使用与死亡和残疾结局之间的关联。这是一项多中心前瞻性观察研究。该研究在澳大利亚和新西兰的 11 个 ICU 进行。数据收集时间为 2017 年 4 月 1 日至 2018 年 10 月 1 日。纳入 357 例成人颅内动脉瘤性蛛网膜下腔出血患者。主要结局是描述抗癫痫药物处方模式。次要结局为 6 个月时的死亡或残疾（改良 Rankin 量表（mRS）评分≥4），以及与抗癫痫药物治疗的关系，以及相关的临床亚组。40%的患者接受了抗癫痫药物治疗，最常用的药物是左乙拉西坦。抗癫痫药物治疗的中位时间为 8 天（IQR 4.5-12.5）。有一些有院前发作的患者未接受抗癫痫药物治疗（14/55，2725%）。抗癫痫药物治疗与影像学和临床分级更高的颅内动脉瘤性蛛网膜下腔出血呈正相关。6 个月时死亡或残疾（mRS≥4）与抗癫痫药物治疗和不治疗之间无显著相关性。对抗癫痫药物治疗与 WFNS 分级之间的交互作用进行检验提示，较低级别的颅内动脉瘤性蛛网膜下腔出血患者使用抗癫痫药物治疗可能预后更差（p=0.04）。总之，澳大利亚颅内动脉瘤性蛛网膜下腔出血患者抗癫痫药物的处方存在跨站点和站点内的差异，大多数患者未接受抗癫痫药物化学预防。我们没有发现 6 个月时死亡或残疾与使用抗癫痫药物之间存在显著相关性。在较低级别颅内动脉瘤性蛛网膜下腔出血患者中，可能存在预后更差的关联。这一发现需要进一步探讨。
