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Is this Subarachnoid Hemorrhage Significant? A National Survey of Neurosurgeons.
MedLine Citation:
PMID:  22931706     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
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.
Authors:
Jeffrey J Perry; Cheryl Symington; Marlène Mansour; Monica Taljaard; Ian G Stiell
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques     Volume:  39     ISSN:  0317-1671     ISO Abbreviation:  Can J Neurol Sci     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0415227     Medline TA:  Can J Neurol Sci     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  638-43     Citation Subset:  IM    
Affiliation:
Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario, Canada.
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