Case fatality and functional outcome after spontaneous subarachnoid haemorrhage: A systematic review and meta-analysis of time trends and regional variations in population-based studies.

IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY
European Stroke Journal Pub Date : 2024-09-01 Epub Date: 2024-02-14 DOI:10.1177/23969873241232823
Andreas Ziebart, Judith Dremel, Svetlana Hetjens, Dennis J Nieuwkamp, Francisca Hh Linn, Nima Etminan, Gabriel Je Rinkel
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引用次数: 0

Abstract

Introduction: A previous systematic review of population-based studies from 1973 to 2002 found a decrease in case fatality for spontaneous subarachnoid haemorrhage, but could not find a sufficient number of studies to assess changes in functional outcome. Since then, treatment has advanced distinctly. We assessed whether case fatality has decreased further and whether functional outcome has improved.

Patients and methods: We searched PubMed and Web of Science for new population-based studies using the same criteria as in our previous systematic review. We assessed changes in case fatality and functional outcome over time using linear regression.

Results: We included 24 new studies with 827 patients and analysed 9542 patients described in 62 study periods between 1973 and 2017. Case fatality decreased by 0.3% (95% CI: -0.7 to 0.1) per year. In a sensitivity analysis excluding studies that did not provide 1-month outcome and outliers, the age and sex-adjusted decrease was 0.1% per year (95% CI: -0.9 to 0.6). The mean case fatality rate decreased from 47% (95% CI: 31-63) in the 1970s to 35% (95% CI: 30-39) in the 1990s, and remained stable in the 2000s (34%; 95% CI: 27-41) and 2010s (38%; 95% CI: 15-60). In 15 studies, the mean proportion of patients living independently increased by 0.2% per year (95%CI: -0.7 to 1.1) and the mean was 45% (95% CI: 39-50) in six studies that reported outcome after 12 months.

Discussion and conclusion: From 1973 to 2017, the case-fatality rate of spontaneous subarachnoid haemorrhage declined overall by 13.5%, but remained stable over the last two decades. The data on time trends in functional outcome were inconclusive.

自发性蛛网膜下腔出血后的病死率和功能预后:以人群为基础的研究中的时间趋势和地区差异的系统回顾和荟萃分析。
导言:之前对 1973 年至 2002 年期间的人口研究进行的系统性回顾发现,自发性蛛网膜下腔出血的病死率有所下降,但未能找到足够数量的研究来评估功能结果的变化。从那时起,治疗方法有了明显的进步。我们评估了病死率是否进一步下降以及功能预后是否有所改善:我们在 PubMed 和 Web of Science 上搜索了基于人群的新研究,采用的标准与之前的系统综述相同。我们使用线性回归法评估了病死率和功能预后随时间的变化:我们纳入了 24 项新研究,共收录了 827 名患者,并分析了 1973 年至 2017 年间 62 项研究中描述的 9542 名患者。病死率每年下降 0.3%(95% CI:-0.7 至 0.1)。在一项敏感性分析中,排除了未提供1个月结果的研究和异常值,经年龄和性别调整后,病死率每年下降0.1%(95% CI:-0.9至0.6)。平均病死率从20世纪70年代的47%(95% CI:31-63)下降到20世纪90年代的35%(95% CI:30-39),并在2000年代(34%;95% CI:27-41)和2010年代(38%;95% CI:15-60)保持稳定。在15项研究中,独立生活的患者平均比例每年增加0.2%(95%CI:-0.7至1.1),在6项报告12个月后结果的研究中,独立生活的患者平均比例为45%(95%CI:39至50):从1973年到2017年,自发性蛛网膜下腔出血的病死率总体下降了13.5%,但在过去二十年中保持稳定。功能性结果的时间趋势数据尚无定论。
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来源期刊
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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