Abstract
Both CT angiography and digital subtraction angiography are used to detect aneurysms in patients with subarachnoid hemorrhage. We examined a large multihospital data base to determine how practice is evolving with regard to the use of CT angiography and DSA in patients with ruptured cerebral aneurysm. The Premier Perspective data base was used to identify hospitalizations of patients treated with clipping or coiling of ruptured cerebral aneurysms from 2006-2011. Billing information was used to determine pretreatment and posttreatment use of DSA and CT angiography during hospitalization. A total of 4972 patients (1022 clipping, 3950 coiling) at 116 hospitals were identified. The percentage of patients with SAH who underwent pretreatment CT angiography significantly increased from 20% in 2006 to 44% in 2011 (P < .0001), whereas the percentage of patients who underwent DSA remained unchanged from 96-94% (P = .28). This CT angiography trend was observed in coiling patients (17-42%, P < .0001) and clipping patients (32-54%, P < .0001). There was a significant increase in the percentage of patients who underwent posttreatment imaging from 41% in 2006 to 48% in 2011 (P = .0037). This trend was observed in clipping patients (33-65%, P < .0001) but not coiling patients (43-45%, P = .62). For the pretreatment evaluation of ruptured aneurysms, the use of CT angiography increased from 2006-2011 without a corresponding decrease in the use of DSA. These results raise the question of potential redundancy without added clinical value of the second test.
Highlights
MethodsThe Premier Perspective data base was used to identify hospitalizations of patients treated with clipping or coiling of ruptured cerebral aneurysms from 2006 –2011
BACKGROUND AND PURPOSEBoth CT angiography and digital subtraction angiography are used to detect aneurysms in patients with subarachnoid hemorrhage
The percentage of patients with SAH who underwent pretreatment CT angiography significantly increased from 20% in 2006 to 44% in 2011 (P Ͻ .0001), whereas the percentage of patients who underwent DSA remained unchanged from 96 –94% (P ϭ .28)
Summary
The Premier Perspective data base was used to identify hospitalizations of patients treated with clipping or coiling of ruptured cerebral aneurysms from 2006 –2011. Study Population and Data Retrieval The Perspective data base is a voluntary, fee-supported collection of data developed by Premier, Inc, to assess quality and resource use.[10] As of 2011, the Perspective data base contained information from more than 600 US hospitals and consisted of approximately 15% of hospitalizations nationwide. This data base contains detailed hospitalization information, including patient and hospital demographics, diagnoses, and all billed items including procedures and diagnostic tests administered in relation to the day of admission.
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