Trends in Transcranial Doppler Monitoring in Aneurysmal Subarachnoid Hemorrhage: A 10-Year Analysis of the Nationwide Inpatient Sample

Abstract

Transcranial Doppler (TCD) is endorsed by national guidelines for use in aneurysmal subarachnoid hemorrhage (aSAH) for surveillance of cerebral vasospasm (CV). However, nationwide data on utilization of TCD for CV detection and monitoring in aSAH are lacking. Analysis of nationwide trends in TCD prevalence was performed using Nationwide Inpatient Sample (NIS) data from 2002 to 2011. Raw counts were converted into weighted counts, which were used to generate national estimates. Teaching hospitals were examined separately for TCD utilization rates. All analyses accounted for the complex sampling design and sample discharge weights of the NIS, following Healthcare Cost and Utilization Project-NIS recommendations. The objective was to estimate the proportion of patients with aSAH receiving TCD monitoring using the NIS. Between 2002 and 2011, a total of 256,089 patients were discharged with a diagnosis of aSAH, of which 3850 underwent TCD monitoring. aSAH accounted for an average of 67.1 discharges per 100,000 annually (95% confidence interval [CI] 61.3-72.8). Of these, 1.5% (95% CI 0.4-2.6) underwent TCD examination. In teaching hospitals, aSAH accounted for an average of 108.5 discharges per 100,000 biennially (95% CI, 96.2-120.8), of which 2% (95% CI 1.0-4.0) underwent TCD examination. TCD utilization increased from <1% during the 2002-2005 period to ≥1.5% during the 2006-2011 period (odds ratio 2.3, 95% CI 1.0-5.7), an increase also seen in teaching hospitals. TCD is underused nationally in the care of aSAH. Whereas the prevalence of TCD is low in teaching hospitals, it is nearly nonexistent in nonteaching hospitals.