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首页> 外文期刊>The Canadian Journal of Neurological Sciences: le Journal Canadien des Sciences Neurologiques >Is this subarachnoid hemorrhage significant? A National Survey of Neurosurgeons.
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Is this subarachnoid hemorrhage significant? A National Survey of Neurosurgeons.

机译：这种蛛网膜下腔出血严重吗？全国神经外科医师调查。

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摘要

Previously all subarachnoid hemorrhage (SAH) patients were admitted, whereas now patients with angiography may be discharged. To survey neurosurgeons to determine current practice and what constitutes a clinically significant subarachnoid hemorrhage. Methods: We surveyed all neurosurgeons listed in the Canadian Medical Directory. We used a modified Dillman technique with up to five mailed surveys plus a pre-notification letter. Neurosurgeons rated the significance of 13 scenarios of subarachnoid hemorrhage. Scenarios varied from aneurysmal subarachnoid hemorrhage to patients with isolated xanthochromia in cerebrospinal fluid. Each scenario was rated for clinical significance using a 5-point scale [1(always) to 5(never)]. Of the 224 surveyed, 115 neurosurgeons responded. Scenarios with aneurysms requiring intervention, arteriovenous malformations, death or any surgical intervention all had median responses of 1 (IQR 1, 1). Scenarios having xanthochromia and few red blood cells in cerebrospinal fluid with negative computerized tomogram (CT) and angiography had median responses of 3 (IQR 1, 4). Scenarios with perimesencephalic pattern on CT with negative angiography had median of 3 (IQR 2, 4). Scenarios where patient is discharged from the emergency department had median of 4 (IQR 3, 5). Subarachnoid hemorrhages due to aneurysms or arteriovenous malformations causing death or requiring surgical intervention are always clinically significant. Other types of nonaneurysmal subarachnoid hemorrhages had inconsistent ratings for clinical significance. These survey results highlight the need for further discussions to standardize the diagnosis of what constitutes a clinically significant subarachnoid hemorrhage and what care should be afforded to these patients.
机译：以前所有的蛛网膜下腔出血（SAH）患者均入院，而现在接受血管造影的患者可能已经出院。调查神经外科医生以确定当前的做法以及什么构成临床上重要的蛛网膜下腔出血。方法：我们调查了《加拿大医学目录》中列出的所有神经外科医生。我们使用了改良的Dillman技术，最多可进行五次邮寄的调查问卷，并附有预先通知信。神经外科医师对蛛网膜下腔出血13种情况的重要性进行了评估。情况从动脉瘤性蛛网膜下腔出血到脑脊液中孤立的黄褐变患者。使用5分制[1（始终）至5（从不）]对每种情况的临床意义进行评估。在接受调查的224位患者中，有115位神经外科医生对此做出了回应。需要进行干预，动静脉畸形，死亡或进行任何外科手术的动脉瘤病例的中位反应均为1（IQR 1，1）。脑脊髓液中黄变色症和红细胞少，计算机断层扫描（CT）和血管造影结果均为阴性的情况的中位反应为3（IQR 1、4）。血管造影检查阴性的CT上的脑中脑型病例的中位数为3（IQR 2、4）。从急诊科出院的患者的中位数为4（IQR 3，5）。由于动脉瘤或动静脉畸形导致死亡或需要手术干预的蛛网膜下腔出血在临床上始终具有重要意义。其他类型的非动脉瘤性蛛网膜下腔出血的临床意义评分不一致。这些调查结果突显了进一步讨论的必要性，以标准化对什么构成临床上重要的蛛网膜下腔出血以及应该为这些患者提供何种护理的诊断。

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