Treatment of Aneurysmal Subarachnoid Haemorrhage in Germany: A Nationwide Analysis of the Years 2005-2009

Walendy, Victor; Strauß, Christian; Rachinger, Jens; Stang, Andreas

doi:10.1159/000355843

Cited by 19 publications

(7 citation statements)

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“…For this study we analyzed 10,244,649 hospitalizations of patients < 18 years between 2014 and 2018 from all hospitals in Germany. Information on the structure of the DRG data set is supplied by the Federal Bureau of Statistics and has been described in detail elsewhere (6)(7)(8). More information is available on https://www.forschungsdatenzentrum.de/en/health/drg.…”

Section: Methodsmentioning

confidence: 99%

Hospitalization and Morbidity Rates After Pediatric Traumatic Brain Injury: A Nation-Wide Population-Based Analysis

et al. 2021

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Background: Even though traumatic brain injury (TBI) is a major cause of morbidity and mortality in children around the globe, population-based and nation-wide data to assess the burden of TBI is scarce.Methods:Based on diagnosis related groups from nation-wide hospital data, we extracted data on all TBI-related hospitalizations in children <18 years in Germany between 2014 and 2018. We calculated crude, age-specific and standardized incidence rates for hospitalizations, imaging, intracranial injury, neurosurgery, and mortality.Results:Out of 10.2 million hospitalizations, we identified 458,844 cases with TBI as primary or secondary diagnosis, resulting in a crude incidence rate of 687/100,000 child years (CY). Age-specific rates of computed tomography were below 30/100,000 CY until the age of 10 years and increased to 162/100,000 CY until 17 years of age. Intracranial injury was diagnosed in 2.7%, neurosurgery was performed in 0.7% of patients, and 0.7% were mechanically ventilated. Mortality was 0.67/100,000 CY (0.1%).Conclusions:Despite substantial hospitalization rates for pediatric TBI in Germany, the rates of imaging, the need for mechanical ventilation, neurosurgery and mortality were overall very low. Reasons for hospitalization and measures to reduce unnecessary admissions warrant further investigation.

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Section: Methodsmentioning

confidence: 99%

Hospitalization and Morbidity Rates After Pediatric Traumatic Brain Injury: A Nation-Wide Population-Based Analysis

et al. 2021

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“…12 23–25 This is not surprising as the highest UIA prevalence is estimated to be in a population with a mean age of 50 years 21. We hypothesise that one possible reason for the unimodal peak of age-specific rates might be that increased age is positively associated with conservative treatment of UIA.…”

Section: Discussionmentioning

confidence: 90%

Clinical management of unruptured intracranial aneurysm in Germany: a nationwide observational study over a 5-year period (2005–2009)

Walendy

Stang

2017

BMJ Open

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ObjectivesOur aim was to provide nationwide age-standardised rates (ASR) on the usage of endovascular coiling and neurosurgical clipping for unruptured intracranial aneurysm (UIA) treatment in Germany.SettingNationwide observational study using the Diagnosis-Related-Groups (DRG) statistics for the years 2005–2009 (overall 83 million hospitalisations).ParticipantsFrom 2005 to 2009, overall 39 155 hospitalisations with a diagnosis of UIA occurred in Germany.Primary outcome measuresAge-specific and age-standardised hospitalisation rates for UIA with the midyear population of Germany in 2007 as the standard.ResultsOf the 10 221 hospitalisations with UIA during the observation period, 6098 (59.7%) and 4123 (40.3%) included coiling and clipping, respectively. Overall hospitalisation rates for UIA increased by 39.5% (95% CI 24.7% to 56.0%) and 50.4% (95% CI 39.6% to 62.1%) among men and women, respectively. In 2005, the ASR per 100 000 person years for coiling was 0.7 (95% CI 0.62 to 0.78) for men and 1.7 (95% CI 1.58 to 1.82) for women. In 2009, the ASR was 1.0 (95% CI 0.90 to 1.10) and 2.4 (95% CI 2.24 to 2.56), respectively. Similarly, the ASR for clipping in 2005 amounted to 0.6 (95% CI 0.52 to 0.68) for men and 1.1 (95% CI 1.00 to 1.20) for women. These rates increased in 2009 to 0.8 (95% CI 0.72 to 0.88) and 1.7 (95% CI 1.58 to 1.82), respectively. We observed a marked geographical variation of ASR for coiling and less pronounced for clipping. For the federal state of Saarland, the ASR for coiling was 5.64 (95% CI 4.76 to 6.52) compared with 0.68 (95% CI 0.48 to 0.88; per 100 000 person years) in Saxony-Anhalt, whereas, ASR for clipping were highest in Rhineland-Palatinate (2.48, 95% CI 2.17 to 4.75) and lowest in Saxony-Anhalt (0.52, 95% CI 0.34 to 0.70).ConclusionsTo the best of our knowledge, we presented the first representative, nationwide analysis of the clinical management of UIA in Germany. The ASR increased markedly and showed substantial geographical variation among federal states for all treatment modalities during the observation period.

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“…As an alternative to previous RCTs with poor-grade aSAH, nationwide database reports are available; however, such reports do not always include accurate clinical grade assessment of aSAH. 15,[20][21][22][23] In addition, aSAH is best managed by experienced surgeons at highvolume cerebrovascular centers; however, data from such centers represent only a part of the data available in nationwide databases. 24 To comprehensively study poor-grade aSAH, the use of large data sets from high-volume cerebrovascular centers that can manage both SC and EC at an equal level with the same neurosurgery team and reduction in the bias of these data are necessary.…”

Section: Discussionmentioning

confidence: 99%

Superiority of Endovascular Coiling Over Surgical Clipping for Clinical Outcomes at Discharge in Patients With Poor-Grade Subarachnoid Hemorrhage: A Registry Study in Japan

Ishikawa,

Ikawa,

Ichihara

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: The differences in clinical outcomes between endovascular coiling (EC) and surgical clipping (SC) in patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH) are controversial. Therefore, this study aimed to evaluate whether EC is superior to SC and identify risk factors in patients with poor-grade aSAH. METHODS: We used data from the “Predict for Outcome Study of aneurysmal SubArachnoid Hemorrhage.” World Federation of Neurological Societies (WFNS) grade III–V aSAH was defined as poor-grade aSAH, and unfavorable clinical outcomes (modified Rankin Scale scores 3-6) were compared between SC and EC after propensity score matching (PSM). In-hospital mortality was similarly evaluated. Predictors of unfavorable clinical outcomes were identified using multivariable analysis. RESULTS: Ultimately, 1326 (SC: 847, EC: 479) and 632 (SC: 316, EC: 316) patients with poor-grade aSAH were included before and after PSM, respectively. Unfavorable clinical outcomes at discharge were significantly different between SC and EC before (72.0% vs 66.2%, P = .026) and after PSM (70.6% vs 63.3%, P = .025). In-hospital mortality was significantly different between groups before PSM (10.5% vs 16.1%, P = .003) but not after PSM (10.4% vs 12.7%, P = .384). Predictors of unfavorable clinical outcomes in both SC and EC were WFNS grade V, older than 70 years, and Fisher computed tomography (CT) grade 4. Predictors of unfavorable clinical outcomes only in SC were WFNS grade IV (odds ratio: 2.46, 95% CI: 1.22-4.97, P = .012) and Fisher CT grade 3 (4.90, 1.42-16.9, P = .012). Predictors of unfavorable clinical outcome only in EC were ages of 50s (3.35, 1.37-8.20, P = .008) and 60s (3.28, 1.43-7.52, P = .005). CONCLUSION: EC resulted in significantly more favorable clinical outcomes than SC in patients with poor-grade aSAH, without clear differences in in-hospital mortality. The benefit of EC over SC might be particularly remarkable in patients with WFNS grade IV and Fisher CT grade 3.

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Treatment of Aneurysmal Subarachnoid Haemorrhage in Germany: A Nationwide Analysis of the Years 2005-2009

Cited by 19 publications

References 54 publications

Hospitalization and Morbidity Rates After Pediatric Traumatic Brain Injury: A Nation-Wide Population-Based Analysis

Hospitalization and Morbidity Rates After Pediatric Traumatic Brain Injury: A Nation-Wide Population-Based Analysis

Clinical management of unruptured intracranial aneurysm in Germany: a nationwide observational study over a 5-year period (2005–2009)

Superiority of Endovascular Coiling Over Surgical Clipping for Clinical Outcomes at Discharge in Patients With Poor-Grade Subarachnoid Hemorrhage: A Registry Study in Japan

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