Between-center and between-country differences in outcome after aneurysmal subarachnoid hemorrhage in the Subarachnoid Hemorrhage International Trialists (SAHIT) repository

Author:

Dijkland Simone A.1,Jaja Blessing N. R.234,van der Jagt Mathieu5,Roozenbeek Bob67,Vergouwen Mervyn D. I.8,Suarez Jose I.9,Torner James C.10,Todd Michael M.11,van den Bergh Walter M.12,Saposnik Gustavo3413,Zumofen Daniel W.1415,Cusimano Michael D.23416,Mayer Stephan A.17,Lo Benjamin W. Y.18,Steyerberg Ewout W.119,Dippel Diederik W. J.6,Schweizer Tom A.23416,Macdonald R. Loch23416,Lingsma Hester F.1

Affiliation:

1. Departments of Public Health,

2. Division of Neurosurgery and

3. Neuroscience Research Program, Li Ka Shing Knowledge Institute, and

4. Institute of Medical Science and

5. Intensive Care,

6. Neurology, and

7. Radiology and Nuclear Medicine, Erasmus MC–University Medical Center, Rotterdam;

8. Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands;

9. Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, Johns Hopkins University, Baltimore, Maryland;

10. Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa;

11. Department of Anesthesiology, University of Minnesota Medical School, Minneapolis, Minnesota;

12. Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen;

13. Decision Neuroscience Unit, Division of Neurology, St. Michael’s Hospital, University of Toronto;

14. Department of Neurosurgery and

15. Section for Diagnostic and Interventional Neuroradiology, Department of Radiology, Basel University Hospital, University of Basel, Basel, Switzerland

16. Department of Surgery, University of Toronto, Toronto, Ontario;

17. Department of Neurology, Henry Ford Health System, Detroit, Michigan; and

18. Departments of Neurology, Neurosurgery, and Critical Care, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada;

19. Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden;

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.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

Genetics,Animal Science and Zoology

Reference37 articles.

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3. Risk Adjustment In Neurocritical care (RAIN)—prospective validation of risk prediction models for adult patients with acute traumatic brain injury to use to evaluate the optimum location and comparative costs of neurocritical care: a cohort study;Harrison;Health Technol Assess

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