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National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study.

• アブストラクト	OBJECTIVES: To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan. DESIGN: Retrospective study. SETTING: Six hundred and thirty-one primary care institutions in Japan. PARTICIPANTS: Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database. PRIMARY AND SECONDARY OUTCOME MEASURES: Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3-6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1-25 points). RESULTS: In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality. CONCLUSIONS: The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era.
  ジャーナル名	BMJ open
  Pubmed追加日	2023/4/11
  投稿者	Kurogi, Ryota; Kada, Akiko; Ogasawara, Kuniaki; Nishimura, Kunihiro; Kitazono, Takanari; Iwama, Toru; Matsumaru, Yuji; Sakai, Nobuyuki; Shiokawa, Yoshiaki; Miyachi, Shigeru; Kuroda, Satoshi; Shimizu, Hiroaki; Yoshimura, Shinichi; Osato, Toshiaki; Horie, Nobutaka; Nagata, Izumi; Nozaki, Kazuhiko; Date, Isao; Hashimoto, Yoichiro; Hoshino, Haruhiko; Nakase, Hiroyuki; Kataoka, Hiroharu; Ohta, Tsuyoshi; Fukuda, Hitoshi; Tamiya, Nanako; Kurogi, A I; Ren, Nice; Nishimura, Ataru; Arimura, Koichi; Shimogawa, Takafumi; Yoshimoto, Koji; Onozuka, Daisuke; Ogata, Soshiro; Hagihara, Akihito; Saito, Nobuhito; Arai, Hajime; Miyamoto, Susumu; Tominaga, Teiji; Iihara, Koji
  組織名	Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu;University, Fukuoka, Japan.;Department of Clinical Research Management, National Hospital Organization Nagoya;Medical Center, Nagoya, Japan.;Department of Neurosurgery, Iwate Medical University, Morioka, Japan.;Department of Preventive Medicine and Epidemiology, National Cerebral and;Cardiovascular Center, Suita, Japan.;Department of Medicine and Clinical Science, Graduate School of Medical Science,;Kyushu University, Fukuoka, Japan.;Department of Neurosurgery, Gifu University Graduate School of Medicine,;Yanagido, Japan.;Division of Stroke Prevention and Treatment, Department of Neurosurgery,;University of Tsukuba, Tsukuba, Japan.;Department of Neurosurgery, Kobe City General Hospital, Kobe, Japan.;Department of Neurosurgery, Kyorin University, Mitaka, Japan.;Department of Neurosurgery, Neuroendovascular Therapy Center, Aichi Medical;University, Nagakute, Japan.;Department of Neurosurgery, Toyama University, Toyama, Japan.;Department of Neurosurgery, Akita University Graduate School of Medicine, Akita,;Japan.;Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.;Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan.;Department of Neurosurgery, Hiroshima University Hospital, Hiroshima, Japan.;Department of Neurosurgery, Kokura Memorial Hospital, Kita-kyushu, Japan.;Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan.;Department of Neurological Surgery, Okayama University Graduate School of;Medicine, Okayama, Japan.;Department of Neurology, Kumamoto City Hospital, Kumamoto, Japan.;Department of Neurology, Tokyo Saiseikai Central Hospital, Tokyo, Japan.;Department of Neurosurgery, Nara Medical University, Nara, Japan.;Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita,;Department of Neurosurgery, Kochi Medical School, Nankoku, Japan.;Department of Health Services Research, Faculty of Medicine, University of;Tsukuba, Tsukuba, Japan.;Department of Neurosurgery, Graduate School of Medicine, University of Tokyo,;Tokyo, Japan.;Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan.;Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto,;Department of Neurosurgery, Tohoku University Graduate School of Medicine,;Sendai, Japan.;Director General, National Cerebral and Cardiovascular Center Hospital, Suita,;Japan kiihara@ncvc.go.jp.
  Pubmed リンク	https://www.ncbi.nlm.nih.gov/pubmed/37037619/

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