How is vasospasm screening using transcranial Doppler associated with delayed cerebral ischemia and outcomes in aneurysmal subarachnoid hemorrhage?
Delayed cerebral ischemia (DCI) is an independent predictor of an unfavorable outcome after aneurysmal subarachnoid hemorrhage (aSAH). Many centers, but not all, use transcranial Doppler (TCD) to screen for vasospasm to help predict DCI. We used the United Kingdom and Ireland Subarachnoid Haemorrhage (UKISAH) Registry to see if outcomes were better in centers that used TCD to identify vasospasm compared to those that did not.
TCD screening practices were ascertained by national survey in 13 participating centers of the UKISAH. The routine use of TCD was reported by 5 “screening” centers, leaving 7 “non-screening” centers. Using a cross-sectional cohort study design, prospectively collected data from the UKISAH Registry was used to compare DCI diagnosis and favorable outcome (Glasgow Outcome Score 4 or 5) at discharge based on reported screening practice.
A cohort of 2028 aSAH patients treated ≤ 3 days of hemorrhage was analyzed. DCI was diagnosed in 239/1065 (22.4%) and 220/963 (22.8%) of patients in non-screening and screening centers respectively while 847/1065 (79.5%) and 648/963 (67.2%) achieved a favorable outcome. Odds ratios adjusted for age, injury severity, comorbidities, need for cerebrospinal fluid diversion, and re-bleed returned neutral odds of diagnosing DCI of 0.90 (95% CI 0.72–1.12; p value = 0.347) in screening units compared to those of non-screening units but significantly decreased odds of achieving a favorable outcome 0.56 (95% CI 0.42–0.82; p value < 0.001).
Centers that screened for vasospasm using TCD had poorer in-hospital outcomes and similar rates of DCI diagnosis compared to centers that did not.
KeywordsDelayed cerebral ischemia Vasospasm Subarachnoid hemorrhage Aneurysm Neuromonitoring Transcranial Doppler Screening
We thank Professor Mark Hamer for his statistical advice and Dr Alice Harper for her editorial assistance.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
For this type of study, no formal consent was required.
- 2.Dorsch N (2011) A clinical review of cerebral vasospasm and delayed ischaemia following aneurysm rupture. Acta Neurochir Suppl 110:5–6Google Scholar
- 10.Linn F, Rinkel G, Algra A, Van Gijn J. (1996) Incidence of subarachnoid hemorrhage role of region, year, and rate of computed tomography: a meta-analysis. Stroke; 27:625–629Google Scholar