Hop J W, Rinkel G J, Algra A, van Gijn J
University Department of Neurology, Utrecht, Netherlands.
Stroke. 1997 Mar;28(3):660-4. doi: 10.1161/01.str.28.3.660.
During the last three decades, new management strategies have been developed for patients with aneurysmal subarachnoid hemorrhage. To assess whether the case-fatality rate has improved after the introduction of new management strategies, we studied outcome in all population-based studies from 1960 onward.
To identify population-based studies that reported on case-fatality rate in subarachnoid hemorrhage, we performed a MEDLINE search and checked all reference lists of the studies found. Two authors (J.W.H. and G.J.E.R.) independently assessed all studies for eligibility, using predefined criteria for case finding and diagnosis, and extracted data on case-fatality rates. We used weighted linear regression analysis to quantify change in case-fatality rate over time. We found 21 studies, describing 25 study periods between 1960 and 1992. Case-fatality rates varied between 32% and 67%, with the exception of one recent study. The case-fatality rate decreased by 0.5% per year (95% confidence interval, -0.1 to 1.2); the decline was steeper after adjustment for age and sex (0.9% per year; 95% confidence interval, -0.7 to 2.6; data from 12 studies).
The case-fatality rate after subarachnoid hemorrhage has decreased during the last three decades. A plausible explanation for this decrease is the improved management of patients with subarachnoid hemorrhage.
在过去三十年中，已为动脉瘤性蛛网膜下腔出血患者制定了新的管理策略。为了评估新管理策略引入后病死率是否有所改善，我们研究了1960年以来所有基于人群的研究结果。
为了确定报告蛛网膜下腔出血病死率的基于人群的研究，我们进行了MEDLINE检索，并检查了所发现研究的所有参考文献列表。两位作者（J.W.H.和G.J.E.R.）使用预先定义的病例发现和诊断标准，独立评估所有研究的合格性，并提取病死率数据。我们使用加权线性回归分析来量化病死率随时间的变化。我们发现了21项研究，描述了1960年至1992年之间的25个研究时期。除一项近期研究外，病死率在32%至67%之间。病死率每年下降0.5%（95%置信区间，-0.1至1.2）；在对年龄和性别进行调整后，下降更为明显（每年0.9%；95%置信区间，-0.7至2.6；来自12项研究的数据）。
在过去三十年中，蛛网膜下腔出血后的病死率有所下降。这种下降的一个合理原因是蛛网膜下腔出血患者管理的改善。
