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Large practice variations in diagnosis and treatment of delayed cerebral ischemia after subarachnoid hemorrhage

Maud A Tjerkstra1, Dagmar Verbaan1, Bert A Coert1

  • 1Department of Neurosurgery, Amsterdam Neurosciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands.

World Neurosurgery
|January 16, 2022
PubMed

Insights

Delayed cerebral ischemia (DCI) following subarachnoid hemorrhage (SAH) lacks uniform definition and treatment. This study reveals significant variations in DCI care among Dutch hospitals, highlighting the need for standardized management protocols.

Area of Science:

  • Neurology
  • Critical Care Medicine
  • Neurosurgery

Background:

  • Delayed cerebral ischemia (DCI) is a major cause of poor outcomes after subarachnoid hemorrhage (SAH).
  • The pathophysiology of DCI remains poorly understood, leading to a lack of uniform definition, diagnostic tests, and evidence-based treatments.
  • This knowledge gap contributes to significant variations in patient care.

Purpose of the Study:

  • To investigate the variations in the definition, diagnosis, and treatment of DCI among healthcare professionals in the Netherlands.
  • To identify inconsistencies in DCI management protocols across different hospitals.

Main Methods:

  • A web-based survey was distributed to 314 intensivists, neurologists, and neurosurgeons across 9 Dutch hospitals.
  • Responders were categorized based on their role in coordinating SAH care.
  • Responses regarding definition and diagnosis were analyzed from coordinating physicians, while treatment responses included all evaluable participants.

Main Results:

  • A 34% response rate (106/314) was achieved, with 79 responses used for analysis.
  • Significant variability was observed: 44% of coordinating physicians required vasospasm signs for DCI diagnosis, and 51% did not rely on diagnostic test results.
  • Treatment inconsistencies included 45% of responders not prescribing nimodipine continuation for patients discharged within 21 days; however, hypertension induction was common.

Conclusions:

  • This study identified substantial variations in the definition, diagnosis, and treatment of DCI in the Netherlands.
  • The absence of evidence-based treatments underscores the need for standardized DCI management strategies.
  • Standardization of care is crucial for optimizing outcomes for patients with SAH-induced DCI.
Abstract

Keywords:
Delayed cerebral ischemiaDiagnosisSubarachnoid hemorrhageSurveyTreatment

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