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Rigante L, van Lieshout JH, Vergouwen MDI, van Griensven CHS, Vart P, van der Loo L, de Vries J, Vinke RS, Etminan N, Aquarius R, Gruber A, Mocco J, Welch BG, Menovsky T, Klijn CJM, Bartels RHMA, Germans MR, Hänggi D, Boogaarts HD. Time trends in the risk of delayed cerebral ischemia after subarachnoid hemorrhage: a meta-analysis of randomized controlled trials. Neurosurg Focus 2022; 52:E2. [DOI: 10.3171/2021.12.focus21473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/21/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Delayed cerebral ischemia (DCI) contributes to morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). Continuous improvement in the management of these patients, such as neurocritical care and aneurysm repair, may decrease the prevalence of DCI. In this study, the authors aimed to investigate potential time trends in the prevalence of DCI in clinical studies of DCI within the last 20 years.
METHODS
PubMed, Embase, and the Cochrane library were searched from 2000 to 2020. Randomized controlled trials that reported clinical (and radiological) DCI in patients with aSAH who were randomized to a control group receiving standard care were included. DCI prevalence was estimated by means of random-effects meta-analysis, and subgroup analyses were performed for the DCI sum score, Fisher grade, clinical grade on admission, and aneurysm treatment method. Time trends were evaluated by meta-regression.
RESULTS
The search strategy yielded 5931 records, of which 58 randomized controlled trials were included. A total of 4424 patients in the control arm were included. The overall prevalence of DCI was 0.29 (95% CI 0.26–0.32). The event rate for prevalence of DCI among the high-quality studies was 0.30 (95% CI 0.25–0.34) and did not decrease over time (0.25% decline per year; 95% CI −2.49% to 1.99%, p = 0.819). DCI prevalence was higher in studies that included only higher clinical or Fisher grades, and in studies that included only clipping as the treatment modality.
CONCLUSIONS
Overall DCI prevalence in patients with aSAH was 0.29 (95% CI 0.26–0.32) and did not decrease over time in the control groups of the included randomized controlled trials.
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Affiliation(s)
- Luigi Rigante
- Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Mervyn D. I. Vergouwen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | | | - Priya Vart
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Lars van der Loo
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joost de Vries
- Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ruben Saman Vinke
- Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Nima Etminan
- Department of Neurosurgery, Universitätsmedizin Mannheim, Germany
| | - Rene Aquarius
- Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Andreas Gruber
- Department of Neurosurgery, Kepler University Hospital, Linz, Austria
| | - J Mocco
- Department of Neurosurgery, Mount Sinai Health System, New York, New York
| | - Babu G. Welch
- Department of Neurosurgery, University of Texas Southwestern, Dallas, Texas
| | - Tomas Menovsky
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium
| | - Catharina J. M. Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands; and
| | | | - Menno R. Germans
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, Zurich, Switzerland
| | - Daniel Hänggi
- Department of Neurosurgery, Henrich-Heine-University Düsseldorf, Germany
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