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

SAHIT Collaboration, Simone A. Dijkland*, Blessing N. R. Jaja, Mathieu van der Jagt, Bob Roozenbeek, Mervyn D. Vergouwen, Jose Suarez, James C. Torner, Michael M. Todd, Walter M. van den Bergh, Gustavo Saposnik, Daniel W. Zumofen, Michael D. Cusimano, Stephan A. Mayer, Benjamin W. Y. Lo, Ewout W. Steyerberg, Diederik W. J. Dippel, Tom A. Schweizer, R. Loch Macdonald, Hester F. Lingsma

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

OBJECTIVE Differences 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).

METHODS The 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.

RESULTS The 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).

CONCLUSIONS Clinical 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.

Original languageEnglish
Pages (from-to)1132-1140
Number of pages9
JournalJournal of Neurosurgery
Volume133
Issue number4
DOIs
Publication statusPublished - Oct-2020

Keywords

  • aneurysmal subarachnoid hemorrhage
  • center effects
  • quality of care
  • outcome
  • vascular disorders
  • MULTILEVEL LOGISTIC-REGRESSION
  • VEHICLE-CONTROLLED TRIAL
  • TIRILAZAD MESYLATE
  • PREDICTION MODELS
  • CASE-FATALITY
  • DOUBLE-BLIND
  • MANAGEMENT
  • MORTALITY
  • STROKE
  • CARE

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