A Questionnaire Survey of Management of Patients with Aneurysmal Subarachnoid Haemorrhage in Poland.

Mariusz Hofman,Norbert Hajder,Izabela Duda,Łukasz J Krzych

doi:10.3390/ijerph17114161

Abstract

Background: Aneurysmal subarachnoid haemorrhage (aSAH) remains a potentially devastating threat to the brain with a serious impact on mortality and morbidity. We attempted to investigate correspondence between the current guidelines for aSAH management and real clinical practice in Poland. Methods: A web-based questionnaire was performed between 03.2019 and 06.2019. Centres performing neuro-interventional radiology procedures and neuro-critical care were included (n = 29). One response from each hospital was recorded. Results: In three (10.4%) centres, there was no clear protocol for an interventional treatment plan. Endovascular embolisation was predominantly used in 11 (37.9%) hospitals, and microsurgical clipping, in 10 (34.5%). A written protocol for standard anaesthetic management was established only in six (20.7%) centres for coiling and in five (17.2%) for microsurgical clipping. The diagnosis of cerebral vasospasm was based on transcranial Doppler as the first-choice method in seven (24.1%) units. “3-H therapy” was applied by 15 (51.8%) respondents, and “2-H therapy”, by four (13.8%) respondents. In only eight (27.6%) centres were all patients with aSAH being admitted to the ICU. Conclusion: Many discrepancies exist between the available guidelines and clinical practice in aSAH treatment in Poland. Peri-procedural management is poorly standardised. Means must be undertaken to improve patient-oriented treatment and care.

Highlights

Aneurysmal subarachnoid haemorrhage remains a potentially devastating threat to the brain with a serious impact on the mortality, morbidity, physical outcomes, neurocognitive performance and quality of life of the affected population [1,2]
In 2015, Velly and colleagues performed an international multicentre questionnaire study to determine the clinical practice of physicians treating aSAH and to evaluate any discrepancy between practice and published evidence [5]
Of aSAH patients underwent endovascular embolization, while in 10 (34.5%), microsurgical clipping was performed with similar prevalence; eight (27.6%) units performed both types of interventional procedures with similar frequencies

Summary

Introduction

Aneurysmal subarachnoid haemorrhage (aSAH) remains a potentially devastating threat to the brain with a serious impact on the mortality, morbidity, physical outcomes, neurocognitive performance and quality of life of the affected population [1,2]. In 2015, Velly and colleagues performed an international multicentre questionnaire study to determine the clinical practice of physicians treating aSAH and to evaluate any discrepancy between practice and published evidence [5]. They found striking variability amongst the surveyed, with significant differences between countries and participating hospitals. We attempted to investigate correspondence between the current guidelines for aSAH management and real clinical practice in Poland. Centres performing neuro-interventional radiology procedures and neuro-critical care were included (n = 29). Conclusion: Many discrepancies exist between the available guidelines and clinical practice in aSAH treatment in Poland. Means must be undertaken to improve patient-oriented treatment and care

Methods

Results

Discussion

Conclusion