Journal article
Between-center and between-country differences in outcome after aneurysmal subarachnoid hemorrhage in the Subarachnoid Hemorrhage International Trialists (SAHIT) repository
Journal of neurosurgery, Vol.133(4), pp.1132-1140
10/2020
DOI: 10.3171/2019.5.JNS19483
PMID: 31443072
Abstract
OBJECTIVEDifferences in clinical outcomes between centers and countries may reflect variation in patient characteristics, diagnostic and therapeutic policies, or quality of care. The purpose of this study was to investigate the presence and magnitude of between-center and between-country differences in outcome after aneurysmal subarachnoid hemorrhage (aSAH).METHODSThe authors analyzed data from 5972 aSAH patients enrolled in randomized clinical trials of 3 different treatments from the Subarachnoid Hemorrhage International Trialists (SAHIT) repository, including data from 179 centers and 20 countries. They used random effects logistic regression adjusted for patient characteristics and timing of aneurysm treatment to estimate between-center and between-country differences in unfavorable outcome, defined as a Glasgow Outcome Scale score of 1–3 (severe disability, vegetative state, or death) or modified Rankin Scale score of 4–6 (moderately severe disability, severe disability, or death) at 3 months. Between-center and between-country differences were quantified with the median odds ratio (MOR), which can be interpreted as the ratio of odds of unfavorable outcome between a typical high-risk and a typical low-risk center or country.RESULTSThe proportion of patients with unfavorable outcome was 27% (n = 1599). The authors found substantial between-center differences (MOR 1.26, 95% CI 1.16–1.52), which could not be explained by patient characteristics and timing of aneurysm treatment (adjusted MOR 1.21, 95% CI 1.11–1.44). They observed no between-country differences (adjusted MOR 1.13, 95% CI 1.00–1.40).CONCLUSIONSClinical outcomes after aSAH differ between centers. These differences could not be explained by patient characteristics or timing of aneurysm treatment. Further research is needed to confirm the presence of differences in outcome after aSAH between hospitals in more recent data and to investigate potential causes.
Details
- Title: Subtitle
- Between-center and between-country differences in outcome after aneurysmal subarachnoid hemorrhage in the Subarachnoid Hemorrhage International Trialists (SAHIT) repository
- Creators
- Simone A Dijkland - Departments of Public HealthBlessing N. R Jaja - Division of Neurosurgery and, Neuroscience Research Program, Li Ka Shing Knowledge Institute, and, Institute of Medical Science andMathieu van der Jagt - Intensive CareBob Roozenbeek - Neurology, and, Radiology and Nuclear Medicine, Erasmus MC–University Medical Center, RotterdamMervyn D. I Vergouwen - Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The NetherlandsJose I Suarez - Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, Johns Hopkins University, Baltimore, MarylandJames C Torner - Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IowaMichael M Todd - Department of Anesthesiology, University of Minnesota Medical School, Minneapolis, MinnesotaWalter M van den Bergh - Department of Critical Care, University Medical Center Groningen, University of Groningen, GroningenGustavo Saposnik - Neuroscience Research Program, Li Ka Shing Knowledge Institute, and, Institute of Medical Science and, Decision Neuroscience Unit, Division of Neurology, St. Michael’s Hospital, University of TorontoDaniel W Zumofen - Department of Neurosurgery and, Section for Diagnostic and Interventional Neuroradiology, Department of Radiology, Basel University Hospital, University of Basel, Basel, SwitzerlandMichael D Cusimano - Division of Neurosurgery and, Neuroscience Research Program, Li Ka Shing Knowledge Institute, and, Institute of Medical Science and, Department of Surgery, University of Toronto, Toronto, OntarioStephan A Mayer - Department of Neurology, Henry Ford Health System, Detroit, Michigan; andBenjamin W. Y Lo - Departments of Neurology, Neurosurgery, and Critical Care, Montreal Neurological Institute, McGill University, Montreal, Quebec, CanadaEwout W Steyerberg - Departments of Public Health,, Department of Biomedical Data Sciences, Leiden University Medical Center, LeidenDiederik W. J Dippel - Neurology, andTom A Schweizer - Division of Neurosurgery and, Neuroscience Research Program, Li Ka Shing Knowledge Institute, and, Institute of Medical Science and, Department of Surgery, University of Toronto, Toronto, OntarioR. Loch Macdonald - Division of Neurosurgery and, Neuroscience Research Program, Li Ka Shing Knowledge Institute, and, Institute of Medical Science and, Department of Surgery, University of Toronto, Toronto, OntarioHester F Lingsma - Departments of Public HealthSAHIT Collaboration
- Resource Type
- Journal article
- Publication Details
- Journal of neurosurgery, Vol.133(4), pp.1132-1140
- DOI
- 10.3171/2019.5.JNS19483
- PMID
- 31443072
- NLM abbreviation
- J Neurosurg
- ISSN
- 0022-3085
- eISSN
- 1933-0693
- Language
- English
- Date published
- 10/2020
- Academic Unit
- Epidemiology; Surgery; Anesthesia; Injury Prevention Research Center; Neurosurgery
- Record Identifier
- 9984214725602771
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