Variations across Europe in national guidelines and clinical practice regarding screening of cognitive and emotional consequences after aneurysmal subarachnoid hemorrhage

Introduction: Many survivors of aneurysmal subarachnoid hemorrhage (aSAH) experience cognitive and emotional consequences that negatively affect participation and quality of life. These invisible consequences often go unrecognized making systematic screening important. However, there may be variations across countries in how these consequences are screened for. Objective: To examine variations in guideline recommendations and clinical practice regarding screening of cognitive and emotional consequences after aSAH across Europe. Methods: National (a)SAH guidelines from 39 European Association of Neurosurgical Societies (EANS) member countries were identified through direct contact with one neurosurgeon per country and additional searches, and were reviewed for recommendations on cognitive and emotional screening. The same representatives were invited for a cross-sectional online survey on clinical screening practices in their center. Results: Eleven of 39 national guidelines (28%) were identified; six recommended cognitive screening, two emotional screening. Fourteen of 38 members (37%) completed the survey. Nine centers (64%) performed cognitive screening in <50% of patients discharged home from the hospital, three centers (21%) screened 50-89% of patients, and two centers (14%) screened ≥90% of patients. Thirteen centers (93%) performed emotional screening in <50% of patients, and one center (7%) in ≥90% of patients. Timing of screening ranged from before hospital discharge to more than eight weeks afterward. Conclusion: A minority of European countries seem to have SAH guidelines and few recommend screening of cognitive and emotional consequences. In most patients, these consequences may remain unscreened. Incorporating routine cognitive and emotional screening into national and local guidelines is crucial to ensure early identification and management.