Published online before print November 13, 2008, doi: 10.1161/STROKEAHA.108.517805
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(Stroke. 2009;40:111.)
© 2009 American Heart Association, Inc.
Original Contributions |
Variation in Outcome After Subarachnoid Hemorrhage
A Study of Neurosurgical Units in UK and Ireland
From Health Services Research Unit (J.L., B.C.R., J.H.v.d.M., J.P.B.), Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK; Clinical Trials and Evaluation Unit (B.C.R.), Clinical Science South Bristol, University of Bristol, UK; Department of Neurosurgery (K.W.L.), Southern General Hospital, Glasgow, UK; Clinical Effectiveness Unit, Royal College of Surgeons of England (J.v.d.M., L.C., J.P.B.), UK; Department of Neurosurgery (P.J.K.), University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK; Department of Neuroradiology (A.R.G.), Newcastle General Hospital, Newcastle, UK; Department of Neuroradiology (A.J.M.), Radcliffe Infirmary, Oxford, UK; Walton Centre for Neurology & Neurosurgery (D.M.S.), Liverpool, UK.
Correspondence to Julia Langham, MSc, Research Fellow, Health Services Research Unit, Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK. E-mail julia.langham{at}lshtm.ac.uk
Backgrounds and Purpose— The purpose of the study was to describe the characteristics, management, and outcomes of patients with confirmed aneurysmal subarachnoid hemorrhage and to compare outcomes across neurosurgical units (NSUs) in the UK and Ireland.
Methods— A cohort of patients admitted to NSUs with subarachnoid hemorrhage between September 14, 2001 and September 13, 2002 was studied longitudinally. Information was collected to characterize clinical condition on admission and treatment. Death or severe disability, defined by the Glasgow Outcome Score–Extended, was ascertained at 6 months.
Results— Data for 2397 patients with a confirmed aneurysm and no coexisting neurological pathology were collected by all 34 NSUs in the UK and Ireland. Aneurysm repair was attempted in 2198 (91.7%) patients (surgical clipping, 57.7%; endovascular coiling, 41.2%; other repair, 1.0%). Most patients (65.0%) were admitted to the NSU on the same day or the day after their hemorrhage; 32.0% of treated patients had the aneurysm repaired on the day of admission to the NSU (day 0), day 1 or day 2 and a further 39.3% by day 7. Glasgow Outcome Score–Extended at 6 months was obtained for 90.6% of patients (2172), of whom 38.5% had an unfavorable outcome. The median risk of an unfavorable outcome for all patients was 31% (5th and 95th percentiles, 12% and 83%), depending on prerepair prognostic factors. After adjustment for case-mix, the percentage of patients with an unfavorable outcome in each NSU did not differ significantly from the overall mean.
Conclusions— In this study that collected representative data from the UK and Ireland, there was no evidence that the performance of any NSU differed from the average.
Key Words: aneurysmal subarachnoid hemorrhage • embolization • epidemiology • humans • neurosurgical procedures • therapeutic
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