Variation in Outcome After Subarachnoid Hemorrhage A Study of Neurosurgical Units in UK and Ireland
Variation in Outcome After Subarachnoid Hemorrhage A Study of Neurosurgical Units in UK and Ireland
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DOI：
10.1161/strokeaha.108.517805
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发表时间：
2009-01-01
期刊：
影响因子：
8.3
通讯作者：
Browne, John P.
中科院分区：
文献类型：
--
作者：
Langham, Julia;Reeves, Barnaby C.;Browne, John P.
背景和目的：本研究的目的是描述确诊为动脉瘤性蛛网膜下腔出血的患者的特点、治疗方法和结果，并比较英国和爱尔兰神经外科单元(NSU)的预后。方法：对2001年9月14日至2002年9月13日间NSU收治的蛛网膜下腔出血患者进行纵向研究。收集信息以描述入院和治疗时的临床情况。结果-英国和爱尔兰的34个NSU收集了2397名确诊为动脉瘤且没有合并神经病理的患者的数据。动脉瘤修补术2198例(91.7%)，其中手术夹闭术57.7%，血管内栓塞术41.2%，其他修补术1.0%。大多数患者(65.0%)是在出血当天或出血后第二天进入NSU的，32.0%的患者在入院当天(0天)、第1天或第2天进行了动脉瘤修补，39.3%的患者在第7天进行了修补。90.6%的患者(2172例)在6个月时获得格拉斯哥预后评分，其中38.5%的患者预后不良。所有患者不良结局的中位风险为31%(第5和第95百分位数，12%和83%)，这取决于产前的预后因素。在调整了病例组合后，每个NSU的不良结果患者的百分比与总体平均值没有显著差异。结论-在这项收集了英国和爱尔兰代表性数据的研究中，没有证据表明任何NSU的表现与平均水平不同。(笔划。2009年；40：111-118。)
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% (5(th) and 95(th) 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. (Stroke. 2009;40:111-118.)