Radiological alliance for health services researchOutcomes-based Assessment of a New Reference Standard for Delayed Cerebral Ischemia Related to Vasospasm in Aneurysmal Subarachnoid Hemorrhage
Section snippets
Study Population
A retrospective study was performed including consecutive patients admitted to our institution with A-SAH between January 2002 and May 2009. Inclusion criterion was an admission diagnosis of A-SAH documented by noncontrast CT and/or cerebrospinal fluid analysis for SAH and CTA and/or DSA for a ruptured aneurysm. There were no exclusion criteria in this study. Institutional review board approval was obtained and written informed consent was waived.
Review of the medical records was performed for
Study Population Characteristics
A total of 137 consecutive A-SAH patients were included in the statistical analysis. Importantly, no patients were excluded from the study. Clinical and demographic characteristics of the study population are presented in Table 1.
Application of the Reference Standard Design
Applying this new reference standard to the study population, 59% (81/137) of patients were classified as DCI and 41% (56/137) as no DCI. A total of 81 patients were classified as DCI with 70% (57/81) at the primary level, 14% (11/81) at the secondary level, and 16%
Discussion
It is well-recognized that a perfect reference standard for DCI does not exist; however, the challenge remains to apply the best criteria in order to accurately classify patients in both clinical practice and research studies. DCI related to vasospasm after A-SAH is a complex entity involving delayed narrowing of the intracranial arteries that may lead to neurologic deterioration, cerebral infarction, and death. A review of the literature reveals that inconsistent terminology has been used to
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Cited by (8)
Vasospasm: Role of Imaging in Detection and Monitoring Treatment
2021, Neuroimaging Clinics of North AmericaCitation Excerpt :Furthermore, up to 50% of patients with DCI do not show imaging evidence of angiographic VS.6 DCI has emerged as the most clinically relevant diagnosis given the strong association with poor clinical outcomes, cognitive impairment, and quality-of-life metrics.7 DCI is currently diagnosed using a combination of clinical examination, TCD, and CTA/computed tomography perfusion (CTP).7,8 In addition, magnetic resonance (MR) imaging–based studies have shown an added benefit in the evaluation of DCI.
Making Use of the Evidence to Guide Coverage Decisions
2012, Academic RadiologyMicroRNA cerebrospinal fluid profile during the early brain injury period as a biomarker in subarachnoid hemorrhage patients
2022, Frontiers in Cellular NeuroscienceEvaluating Blood-Brain Barrier Permeability in Delayed Cerebral Infarction after Aneurysmal Subarachnoid Hemorrhage
2015, American Journal of Neuroradiology
This publication was made possible by grant number 5K23NS058387-02 from the National Institute of Neurological Disorders and Stroke (NINDS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NINDS or NIH.