International practice variability in treatment of aneurysmal subarachnoid hemorrhage

Jordi de Winkel, Mathieu van der Jagt, Hester F. Lingsma, Bob Roozenbeek, Eusebia Calvillo, Sherry H.Y. Chou, Peter H. Dziedzic, Nima Etminan, Judy Huang, Nerissa U. Ko, Robert Loch Macdonald, Renee L. Martin, Niteesh R. Potu, Chethan P. Venkatasubba Rao, Mervyn D.I. Vergouwen, Jose I. Suarez*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Prior research suggests substantial between-center differences in functional outcome following aneurysmal subarachnoid hemorrhage (aSAH). One hypothesis is that these differences are due to practice variability. To characterize practice variability, we sent a survey to 230 centers, of which 145 (63%) responded. Survey respondents indicated that an estimated 65% of ruptured aneurysms were treated endovascularly. Sixty-five percent of aneurysms were treated within 24 h of symptom onset, 18% within 24–48 h, and eight percent within 48–72 h. Centers in the United States (US) and Europe (EU) treat aneurysms more often endovascularly (72% and 70% vs. 51%, respectively, US vs. other p < 0.001, and EU vs. other p < 0.01) and more often within 24 h (77% and 64% vs. 46%, respectively, US vs. other p < 0.001, EU vs. other p < 0.01) compared to other centers. Most centers aim for euvolemia (96%) by administrating intravenous fluids to 0 (53%) or +500 mL/day (41%) net fluid balance. Induced hypertension is more often used in US centers (100%) than in EU (87%, p < 0.05) and other centers (81%, p < 0.05), and endovascular therapies for cerebral vasospasm are used more often in US centers than in other centers (91% and 60%, respectively, p < 0.05). We observed significant practice variability in aSAH treatment worldwide. Future comparative effectiveness research studies are needed to investigate how practice variation leads to differences in functional outcome.

Original languageEnglish (US)
Article number762
Pages (from-to)1-14
Number of pages14
JournalJournal of Clinical Medicine
Issue number4
StatePublished - Feb 2 2021


  • Aneurysm treatment
  • Delayed cerebral ischemia
  • Fluid management
  • Outcome
  • Practice variation
  • Subarachnoid hemorrhage
  • Vasospasm

ASJC Scopus subject areas

  • Medicine(all)


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