Key result
Treatment center was associated with significant differences in unfavorable outcome after aneurysmal subarachnoid hemorrhage (adjusted MOR 1.21), independent of patient characteristics and treatment timing.
Why the study?
Differences in clinical outcomes between centers and countries may reflect variation in patient characteristics, diagnostic and therapeutic policies, or quality of care, but their presence and magnitude after aneurysmal subarachnoid hemorrhage were unknown.
Observational (n=5,972)
Yes
Answers are grounded in this paper and cite their sources.
Clinical outcomes after aneurysmal subarachnoid hemorrhage differ significantly between centers, independent of patient characteristics and timing of treatment, highlighting potential variations in quality of care.
OBJECTIVE: Differences in clinical outcomes between centers and countries may reflect variation in patient characteristics, diagnostic and therapeutic policies, or quality of care. The purpose of this study was to investigate the presence and magnitude of between-center and between-country differences in outcome after aneurysmal subarachnoid hemorrhage (aSAH). METHODS: The authors analyzed data from 5972 aSAH patients enrolled in randomized clinical trials of 3 different treatments from the Subarachnoid Hemorrhage International Trialists (SAHIT) repository, including data from 179 centers and 20 countries. They used random effects logistic regression adjusted for patient characteristics and timing of aneurysm treatment to estimate between-center and between-country differences in unfavorable outcome, defined as a Glasgow Outcome Scale score of 1-3 (severe disability, vegetative state, or death) or modified Rankin Scale score of 4-6 (moderately severe disability, severe disability, or death) at 3 months. Between-center and between-country differences were quantified with the median odds ratio (MOR), which can be interpreted as the ratio of odds of unfavorable outcome between a typical high-risk and a typical low-risk center or country. RESULTS: The proportion of patients with unfavorable outcome was 27% (n = 1599). The authors found substantial between-center differences (MOR 1.26, 95% CI 1.16-1.52), which could not be explained by patient characteristics and timing of aneurysm treatment (adjusted MOR 1.21, 95% CI 1.11-1.44). They observed no between-country differences (adjusted MOR 1.13, 95% CI 1.00-1.40). CONCLUSIONS: Clinical outcomes after aSAH differ between centers. These differences could not be explained by patient characteristics or timing of aneurysm treatment. Further research is needed to confirm the presence of differences in outcome after aSAH between hospitals in more recent data and to investigate potential causes.
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Dijkland et al. (2019) conducted an observational in Aneurysmal subarachnoid hemorrhage (n=5,972). Treatment center vs. Other treatment centers was evaluated on Unfavorable outcome (Glasgow Outcome Scale score of 1-3 or modified Rankin Scale score of 4-6) at 3 months (MOR 1.21, 95% CI 1.11-1.44). Treatment center was associated with significant differences in unfavorable outcome after aneurysmal subarachnoid hemorrhage (adjusted MOR 1.21), independent of patient characteristics and treatment timing.
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