Abstract TMP104: Prevalence of Transcranial Doppler Monitoring in Aneurysmal Subarachnoid Hemorrhage: An Analysis of the Nationwide Inpatient Sample

Abstract

Background and Objective: Transcranial Doppler (TCD) is endorsed by the American Heart Association/American Stroke Association, the American Academy of Neurology, and the Neurocritical Care Society for use in aneurysmal subarachnoid hemorrhage (aSAH) for surveillance of cerebral vasospasm (CV). However, data on utilization of TCD for CV detection and monitoring in aSAH are lacking. We estimated the proportion of patients with aSAH receiving TCD monitoring using the Nationwide Inpatient Sample (NIS). Methods: Data from 2002-2011 NIS were used to calculate the number of discharges with a primary diagnosis of aSAH per 100,000 discharges. Descriptive analysis of nationwide trends in TCD prevalence was performed. Teaching hospitals were examined separately for TCD utilization rates and this was done biennially to prevent small numbers. Results: Between 2002 and 2011, a total of 256,089 patients were discharged with a diagnosis of aSAH of which 3,850 underwent TCD monitoring. aSAH accounted for an average of 67.1 discharges per 100,000 annually (95% CI 61.3-72.8) from 2002-2011. Of these, only 1.5% (95% CI 0.4-2.6) underwent TCD examination. In teaching hospitals, aSAH accounted for an average of 108.5 discharges per 100,000 biennially (95% CI, 96.2-120.8), of which 2% (95% CI 1.0-4.0) underwent TCD examination. TCD utilization increased from <1% during the 2002-2005 period, to ≥1.5% during the 2006-2011 period (OR 2.3, 95% CI 1.0-5.7), an increase also seen in teaching hospitals. Conclusion: TCD is underutilized nationally in the care of aSAH. While the prevalence of TCD is low in teaching hospitals, it is nearly nonexistent in non-teaching hospitals.