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Is this Subarachnoid Hemorrhage Significant? A National Survey of Neurosurgeons

Published online by Cambridge University Press:  02 December 2014

Jeffrey J. Perry ,
Cheryl Symington ,
Marlène Mansour ,
Monica Taljaard  and
Ian G. Stiell
Jeffrey J. Perry*
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario, Canada
Cheryl Symington
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
Marlène Mansour
Affiliation:
Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
Monica Taljaard
Affiliation:
Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
Ian G. Stiell
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario, Canada
*
Clinical Epidemiology Unit, F6 Ottawa Hospital Research Institute, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada. Email: jperry@ohri.ca
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Abstract

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Background:

Previously all subarachnoid hemorrhage (SAH) patients were admitted, whereas now patients with angiography may be discharged.

Objective:

To survey neurosurgeons to determine current practice and what constitutes a clinically significant subarachnoid hemorrhage.

Methods:

We surveyed all neurosurgeons listed in the Canadian Medical Directory. We used a modified Dillman technique with up to five mailed surveys plus a pre-notification letter. Neurosurgeons rated the significance of 13 scenarios of subarachnoid hemorrhage. Scenarios varied from aneurysmal subarachnoid hemorrhage to patients with isolated xanthochromia in cerebrospinal fluid. Each scenario was rated for clinical significance using a 5-point scale [1(always) to 5(never)].

Results:

Of the 224 surveyed, 115 neurosurgeons responded. Scenarios with aneurysms requiring intervention, arteriovenous malformations, death or any surgical intervention all had median responses of 1 (IQR 1, 1). Scenarios having xanthochromia and few red blood cells in cerebrospinal fluid with negative computerized tomogram (CT) and angiography had median responses of 3 (IQR 1, 4). Scenarios with perimesencephalic pattern on CT with negative angiography had median of 3 (IQR 2, 4). Scenarios where patient is discharged from the emergency department had median of 4 (IQR 3, 5).

Conclusion:

Subarachnoid hemorrhages due to aneurysms or arteriovenous malformations causing death or requiring surgical intervention are always clinically significant. Other types of nonaneurysmal subarachnoid hemorrhages had inconsistent ratings for clinical significance. These survey results highlight the need for further discussions to standardize the diagnosis of what constitutes a clinically significant subarachnoid hemorrhage and what care should be afforded to these patients.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue 5 , September 2012 , pp. 638 - 643
Copyright
Copyright © The Canadian Journal of Neurological 2012

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