Artikel
Incidence, therapy and outcome of aneurysmal subarachnoid hemorrhage – The Swiss study on aneurysmal subarachnoid hemorrhage (Swiss SOS)
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Veröffentlicht: | 8. Juni 2016 |
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Objective: Aneurysmal subarachnoid hemorrhage (aSAH) accounts for a large proportion of productive life years lost to stroke. Its management requires a multidisciplinary effort. Much of the presently available data on incidence, treatment and outcomes comes from studies with a strong selection bias, studies confounding all kinds of SAH, i.e. aneurysmal and non-aneurysmal, cohorts of single centers or retrospective series. The aim of this study is to assess incidence, treatment modalities and outcomes after SAH from a prospective national registry.
Method: Patients admitted with aSAH across Switzerland are included starting January 1st 2009. All eight Swiss hospitals providing neurovascular care for aSAH patients participated in the registry. Admission parameters, treatment and outcomes at discharge and one year were recorded. Incidence was calculated after WHO-standardization, age-stratification and based on population data from the Swiss Federal Bureau of Statistics.
Results: From 2009 to 2013, 1580 patients were recorded in the Swiss SOS database. The annual incidence of aSAH in the observation period ranged from 3.56 to 3.95/100,000/year. Its peak of 7.6/100,000/year was reached in the age group 55-59 years. 86% of patients arrived at a tertiary neurovascular care center on the same or within one day of symptom occurrence. The ratio of female to male patients was 2:1. Median age at aSAH was 55 years. Good grade aSAH (World federation of neurosurgical societies (WFNS) grades 1&2) accounted for more 38% and 18% of cases respectively. WFNS grades 3, 4 and 5 made up 7%, 10% and 26% respectively. Fisher grades 1 and 2 accounted for 14% of cases while 86% were Fisher grades 3 and 4. Surgical aneurysm occlusion was performed in 36% and endovascular occlusion in 48% of cases. After a mean length of stay of 20 days, 51% of patients were discharged with good outcome (mRankin <3) and 30% with poor outcome (mRankin 3-5). In-hospital mortality was 19%. At one year, good outcome ranged at 68%.
Conclusions: The results of this first national database on subarachnoid hemorrhage reflect the current standard of care. Annual incidence of aSAH in Switzerland is at the lower end with 3.46 to 3.95/100,000. Our series confirms a current trends towards lower mortality and higher employment of endovascular aneurysm repair compared to historical series.