Artikel
Time trends in the risk of delayed cerebral ischemia after subarachnoid haemorrhage – a meta-analysis of randomised controlled trials
Zeittendenz der verzögert eintretenden zerebralen Ischämie nach aneurysmatischer Subarachnoidalblutung: eine Meta-Analyse randomzierter klinischer Studien
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Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: Delayed cerebral ischemia (DCI) contributes to morbidity and case-fatality after aneurysmal subarachnoid hemorrhage (aSAH). Continuous improvement in management of these patients, such as neurocritical care and aneurysm repair, may have decreased the prevalence of DCI. The aim of this study was to investigate potential time trends in the DCI prevalence in the last 20 years.
Methods: Medline, Embase and the Cochrane library were searched from 2000 to 2020. We included randomized controlled trials which reported clinical (and radiological) DCI in aSAH patients randomized to the control group receiving standard care. DCI prevalence was estimated by means of random effects meta-analysis and subgroup analyses were performed for DCI sum score, (modified) Fisher grade, clinical grade on admission, and aneurysm treatment methods. Time trends were evaluated by meta-regression.
Results: The search strategy yielded 5,931 records, of which 57 randomized controlled trials were included. A total of 4,424 patients in the control arm were included. Overall prevalence of DCI was 0.29 (95% CI 0.26-0.32). 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/year (95% CI – 2.49%, + 1.99%), p=0.819). DCI prevalence was higher in studies including only higher clinical or higher Fisher grades and in studies including only clipping as treatment modality.
Conclusion: Overall DCI prevalence in aSAH patients was 0.29 (95% CI 0.26-0.32) and did not decrease over time in control groups of RCTs. Figure 1 [Fig. 1], Figure 2 [Fig. 2]