None listed
Conditions
Brief summary
Subarachnoid haemorrhage (SAH) accounts for 5% of all strokes, yet 30% of people affected with SAH will die within 90 days and survivors are often disabled. Unlike ischaemic stroke, there is a relatively higher risk of SAH in younger age groups, yet risk factors are ill-defined. Therefore, determining health service variables impacting on outcomes will inform policy and practice. It is now feasible to examine SAH care and its outcomes on a large scale at a relatively modest cost. We will analyse linked routinely collected morbidity and mortality data to explore outcomes and patterns of care in SAH on a large scale. The study will describe discharge destinations and readmissions and be able to quantify the effect of hospital services according to different models of care, resources and settings (eg principal and non-principal referral, neurosurgical vs non-neurosurgical) and neurovascular interventions. Such a large-scale analysis of services and care patterns will be of international significance informing bed-side care and health service planning to improve individual, health service and societal outcomes. We hypothesise that the risk of 30-day, 90-day and 12 month all-cause mortality will be correlated with health service delivery for patients with SAH. Specifically, patients with SAH admitted to a hospital offering a neurosurgical unit will have a reduced risk of all-cause and disease-specific mortality and spend less time in hospital in the year after a SAH. There will be significant variation in all-cause and disease-specific mortality and hospital re-admission according to: hospital type (eg principal referral versus other, rural versus urban location), caseload, and patient and disease characteristics. We will identify emergency presentations and hospital separations for SAH in New South Wales from July 2000 until June 2010. Data from these sources will be linked to the NSW Registry of Birth, Deaths and Marriages (fact of death) and ABS Causes of Death data.
Interventions
Non-traumatic subarachnoid haemorrhage (SAH) accounts for 1 to 7% of all strokes and around 30% with SAH die within one month. SAH is characterised by bleeding in the subarachnoid space between the thin arachnoid and pia mater coverings of the brain. Ruptured cerebral aneurysms account for 85% of non-traumatic SAH.
Using linked administrative data-sets, it is now feasible to examine SAH care. We aim to use routinely collected data to carry out a large-scale analysis of outcomes for SAH. We
Non-traumatic subarachnoid haemorrhage (SAH) accounts for 1 to 7% of all strokes and around 30% with SAH die within one month. SAH is characterised by bleeding in the subarachnoid space between the thin arachnoid and pia mater coverings of the brain. Ruptured cerebral aneurysms account for 85% of non-traumatic SAH. Using linked administrative data-sets, it is now feasible to examine SAH care. We aim to use routinely collected data to carry out a large-scale analysis of outcomes for SAH. We aim to determine short and longer-term quality of care and the safety and efficacy of procedures undertaken to treat SAH in a contemporary acute care setting. Our proposed project is a cost effective, timely alternative to existing labour-intensive efforts to observe SAH care and outcomes. Our methods minimise selection and referral biases, utilising state-wide data from the largest cohort of SAH patients ever studied in Australia (~5,000). Our proposed project aims to analyse linked administrative data-bases to identify patients with SAH and characterise short and long-term outcomes, such as fact and cause of death and re-admission to hospital. Outcomes will be assessed from time of hospital admission to up to 10 years post-hospitalisation.
Sponsors
National Health and Medical Research Council of Australia
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
NSW residents aged 18 years or over with a hospital separation for SAH or who died outside hospital with SAH noted as a cause of death.
Exclusion criteria
Patients with the following criteria will be excluded: -a concomitant code for head trauma or traumatic injury; -residents of other Australian states; -patients with diagnostic codes (as selected by clinical experts) for brain malignancy or benign brain tumour.
Outcome results
None listed