Department of Neurosurgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Department of Neurosurgery, University Medical Center Ulm, Günzburg, Germany.
Eur Stroke J. 2024 Sep;9(3):555-565. doi: 10.1177/23969873241232823. Epub 2024 Feb 14.
A previous systematic review of population-based studies from 1973 to 2002 found a decrease in case fatality for spontaneous subarachnoid haemorrhage, but could not find a sufficient number of studies to assess changes in functional outcome. Since then, treatment has advanced distinctly. We assessed whether case fatality has decreased further and whether functional outcome has improved.
We searched PubMed and Web of Science for new population-based studies using the same criteria as in our previous systematic review. We assessed changes in case fatality and functional outcome over time using linear regression.
We included 24 new studies with 827 patients and analysed 9542 patients described in 62 study periods between 1973 and 2017. Case fatality decreased by 0.3% (95% CI: -0.7 to 0.1) per year. In a sensitivity analysis excluding studies that did not provide 1-month outcome and outliers, the age and sex-adjusted decrease was 0.1% per year (95% CI: -0.9 to 0.6). The mean case fatality rate decreased from 47% (95% CI: 31-63) in the 1970s to 35% (95% CI: 30-39) in the 1990s, and remained stable in the 2000s (34%; 95% CI: 27-41) and 2010s (38%; 95% CI: 15-60). In 15 studies, the mean proportion of patients living independently increased by 0.2% per year (95%CI: -0.7 to 1.1) and the mean was 45% (95% CI: 39-50) in six studies that reported outcome after 12 months.
From 1973 to 2017, the case-fatality rate of spontaneous subarachnoid haemorrhage declined overall by 13.5%, but remained stable over the last two decades. The data on time trends in functional outcome were inconclusive.
先前对 1973 年至 2002 年的基于人群的研究进行的系统评价发现，自发性蛛网膜下腔出血的病死率有所下降，但无法找到足够数量的研究来评估功能结局的变化。此后，治疗明显取得了进展。我们评估病死率是否进一步下降，以及功能结局是否改善。
我们在 PubMed 和 Web of Science 上检索了使用与我们先前系统评价相同标准的新的基于人群的研究。我们使用线性回归来评估随时间变化的病死率和功能结局的变化。
我们纳入了 24 项新的研究，其中包含 827 例患者，分析了 1973 年至 2017 年 62 个研究期间描述的 9542 例患者。病死率每年下降 0.3%（95%CI：-0.7 至 0.1）。在排除未提供 1 个月结局和异常值的研究的敏感性分析中，年龄和性别调整后的下降率为每年 0.1%（95%CI：-0.9 至 0.6）。平均病死率从 20 世纪 70 年代的 47%（95%CI：31-63）降至 90 年代的 35%（95%CI：30-39），在 2000 年代和 2010 年代保持稳定（分别为 34%；95%CI：27-41 和 38%；95%CI：15-60）。在 15 项研究中，每年独立生活的患者比例平均增加 0.2%（95%CI：-0.7 至 1.1），在 6 项报告 12 个月后结局的研究中，平均比例为 45%（95%CI：39-50）。
1973 年至 2017 年，自发性蛛网膜下腔出血的病死率总体下降了 13.5%，但在过去二十年中保持稳定。关于功能结局的时间趋势数据尚无定论。
