Effect of treatment modality on in-hospital outcome in patients with subarachnoid hemorrhage: a nationwide study in Japan (J-ASPECT Study)

Abstract

ABBREVIATIONS BRAT = Barrow Ruptured Aneurysm Trial; CCI = Charlson Comorbidity Index; CSC = comprehensive stroke center; DPC = Diagnosis Procedure Combination; HAC = hospital-acquired condition; ISAT = International Subarachnoid Aneurysm Trial; JCS = Japan Coma Scale; mRS = modified Rankin Scale; PPV = positive predictive value; PSI = patient safety indicator; RCT = randomized controlled trial; SAH = subarachnoid hemorrhage. OBJECTIVE Although heterogeneity in patient outcomes following subarachnoid hemorrhage (SAH) has been observed across different centers, the relative merits of clipping and coiling for SAH remain unknown. The authors sought to compare the patient outcomes between these therapeutic modalities using a large nationwide discharge database encompassing hospitals with different comprehensive stroke center (CSC) capabilities. METHODS They analyzed data from 5214 patients with SAH (clipping 3624, coiling 1590) who had been urgently hospitalized at 393 institutions in Japan in the period from April 2012 to March 2013. In-hospital mortality, modified Rankin Scale (mRS) score, cerebral infarction, complications, hospital length of stay, and medical costs were compared between the clipping and coiling groups after adjustment for patient-level and hospital-level characteristics by using mixedmodel analysis. RESULTS Patients who had undergone coiling had significantly higher in-hospital mortality (12.4% vs 8.7%, OR 1.3) and a shorter median hospital stay (32.0 vs 37.0 days, p < 0.001) than those who had undergone clipping. The respective proportions of patients discharged with mRS scores of 3-6 (46.4% and 42.9%) and median medical costs (thousands US$, 35.7 and 36.7) were not significantly different between the groups. These results remained robust after further adjustment for CSC capabilities as a hospital-related covariate. SUBMITTED

Effect of treatment modality and cerebral vasospasm agent on patient outcomes after aneurysmal subarachnoid hemorrhage in the elderly aged 75 years and older

“…In contrast, better Abbreviations: OR, Odds ratio; CI, confidence interval; EPA, eicosapentaenoic acid functional outcomes after coiling were noted in the non-elderly when compared with the elderly group. Previously, we have shown that in-hospital mortality rates in clipping patients after aSAH in Japan are significantly lower than those in the other countries, while in-hospital mortality rates after coiling are comparable [22]. The present study showed that the relative Although coiling was used more frequently in the elderly when compared with the nonelderly, the proportion of patients who underwent coiling in both groups were similar to that of two previous studies [23,24] that were conducted relatively soon after the publication of the International Subarachnoid Aneurysm Trial (ISAT) [25]; however, our rates were lower than a recent US report [26].…”

Association of Japan Coma Scale score on hospital arrival with in-hospital mortality among trauma patients

“…Briefly, the JCS score consists of four main categories: alert (0) and one-, two-, or three-digit codes based on degree of arousal, each of which has three subcategories. Although previous studies have indicated that JCS score correlates with outcomes in stroke patients [10, 15], the JCS has not been examined among trauma patients.…”

Treatment Modality and Quality Benchmarks of Aneurysmal Subarachnoid Hemorrhage at a Comprehensive Stroke Center

“…In our cohort, seven patients (5.9%) died due to withdrawal of life support per patient wishes or family decision to prevent futile care and prolonged suffering. Case fatality was 11.8% (3.8–19.9%) lower in Japan than it was in Europe, the USA, Australia, and New Zealand ( 1 , 28 ). However, the hospital LOS in Japan was more than 10 days longer, suggestive of prolonged life support for poor grade patients with terminal illness ( 28 ).…”