Time trends in outcome of subarachnoid hemorrhage

医学 蛛网膜下腔出血 病死率 置信区间 人口 入射(几何) 冲程(发动机) 相对风险 改良兰金量表 内科学 人口学 流行病学 缺血性中风 机械工程 物理 环境卫生 缺血 社会学 光学 工程类
作者
Caroline Lovelock,Gabriël J.E. Rinkel,Peter M. Rothwell
出处
期刊:Neurology [Ovid Technologies (Wolters Kluwer)]
卷期号:74 (19): 1494-1501 被引量:432
标识
DOI:10.1212/wnl.0b013e3181dd42b3
摘要

Background: Treatment of aneurysmal subarachnoid hemorrhage (SAH) has changed substantially over the last 25 years but there is a lack of reliable population-based data on whether case-fatality or functional outcomes have improved. Methods: We determined changes in the standardized incidence and outcome of SAH in the same population between 1981 and 1986 (Oxford Community Stroke Project) and 2002 and 2008 (Oxford Vascular Study). In a meta-analysis with other population-based studies, we used linear regression to determine time trends in outcome. Results: There were no reductions in incidence of SAH (RR = 0.79, 95% confidence interval [CI] 0.48–1.29, p = 0.34) and in 30-day case-fatality (RR = 0.67, 95% CI 0.39–1.13, p = 0.14) in the Oxford Vascular Study vs Oxford Community Stroke Project, but there was a decrease in overall mortality (RR = 0.47, 0.23–0.97, p = 0.04). Following adjustment for age and baseline SAH severity, patients surviving to hospital had reduced risk of death or dependency (modified Rankin score > 3) at 12 months in the Oxford Vascular Study (RR = 0.51, 0.29–0.88, p = 0.01). Among 32 studies covering 39 study periods from 1980 to 2005, 7 studied time trends within single populations. Unadjusted case-fatality fell by 0.9% per annum (0.3–1.5, p = 0.007) in a meta-analysis of data from all studies, and by 0.9% per annum (0.2–1.6%, p = 0.01) within the 7 population studies. Conclusion: Mortality due to subarachnoid hemorrhage fell by about 50% in our study population over the last 2 decades, due mainly to improved outcomes in cases surviving to reach hospital. This improvement is consistent with a significant decrease in case-fatality over the last 25 years in our pooled analysis of other similar population-based studies.
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