Stable incidence but declining case-fatality rates of subarachnoid hemorrhage in a population
To characterize temporal trends in subarachnoid hemorrhage (SAH) incidence and outcomes over 5 time periods in a large population-based stroke study in the United States. All SAHs among residents of the Greater Cincinnati/Northern Kentucky region at least 20 years of age were identified and verified...
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Published in | Neurology Vol. 87; no. 21; p. 2192 |
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Main Authors | , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
22.11.2016
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Subjects | |
Online Access | Get more information |
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Summary: | To characterize temporal trends in subarachnoid hemorrhage (SAH) incidence and outcomes over 5 time periods in a large population-based stroke study in the United States.
All SAHs among residents of the Greater Cincinnati/Northern Kentucky region at least 20 years of age were identified and verified via study physician review in 5 distinct year-long study periods between 1988 and 2010. We abstracted demographics, care patterns, and outcomes, and we compared incidence and case-fatality rates across the study periods.
The incidence of SAH in the 5 study periods (age-, race-, and sex-adjusted to the 2000 US population) was 8.8 (95% confidence interval 6.8-10.7), 9.2 (7.2-11.2), 10.0 (8.0-12.0), 9.0 (7.1-10.9), and 7.7 (6.0-9.4) per 100,000, respectively; the trend in incidence rates from 1988 to 2010 was not statistically significant (p = 0.22). Advanced neurovascular imaging, endovascular coiling, and neurologic intensive care unit availability increased significantly over time. All-cause 5-day (32%-18%, p = 0.01; for trend), 30-day (46%-25%, p = 0.001), and 90-day (49%-29%, p = 0.001) case-fatality rates declined from 1988 to 2010. When we included only proven or highly likely aneurysmal SAH, the declines in case-fatality were no longer statistically significant.
Although the incidence of SAH remained stable in this population-based region, 5-day, 30-day, and 90-day case-fatality rates declined significantly. Advances in surgical and medical management, along with systems-based changes such as the emergence of neurocritical care units, are potential explanations for the reduced case-fatality. |
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ISSN: | 1526-632X |
DOI: | 10.1212/wnl.0000000000003353 |