PT  - JOURNAL ARTICLE
AU  - Mackey, Jason
AU  - Khoury, Jane C.
AU  - Alwell, Kathleen
AU  - Moomaw, Charles J.
AU  - Kissela, Brett M.
AU  - Flaherty, Matthew L.
AU  - Adeoye, Opeolu
AU  - Woo, Daniel
AU  - Ferioli, Simona
AU  - De Los Rios La Rosa, Felipe
AU  - Martini, Sharyl
AU  - Khatri, Pooja
AU  - Broderick, Joseph P.
AU  - Zuccarello, Mario
AU  - Kleindorfer, Dawn
TI  - Stable incidence but declining case-fatality rates of subarachnoid hemorrhage in a population
AID  - 10.1212/WNL.0000000000003353
DP  - 2016 Nov 22
TA  - Neurology
PG  - 2192--2197
VI  - 87
IP  - 21
4099  - http://n.neurology.org/content/87/21/2192.short
4100  - http://n.neurology.org/content/87/21/2192.full
SO  - Neurology2016 Nov 22; 87
AB  - Objective: To characterize temporal trends in subarachnoid hemorrhage (SAH) incidence and outcomes over 5 time periods in a large population-based stroke study in the United States.Methods: All SAHs among residents of the Greater Cincinnati/Northern Kentucky region at least 20 years of age were identified and verified via study physician review in 5 distinct year-long study periods between 1988 and 2010. We abstracted demographics, care patterns, and outcomes, and we compared incidence and case-fatality rates across the study periods.Results: The incidence of SAH in the 5 study periods (age-, race-, and sex-adjusted to the 2000 US population) was 8.8 (95% confidence interval 6.8–10.7), 9.2 (7.2–11.2), 10.0 (8.0–12.0), 9.0 (7.1–10.9), and 7.7 (6.0–9.4) per 100,000, respectively; the trend in incidence rates from 1988 to 2010 was not statistically significant (p = 0.22). Advanced neurovascular imaging, endovascular coiling, and neurologic intensive care unit availability increased significantly over time. All-cause 5-day (32%–18%, p = 0.01; for trend), 30-day (46%–25%, p = 0.001), and 90-day (49%–29%, p = 0.001) case-fatality rates declined from 1988 to 2010. When we included only proven or highly likely aneurysmal SAH, the declines in case-fatality were no longer statistically significant.Conclusions: Although the incidence of SAH remained stable in this population-based region, 5-day, 30-day, and 90-day case-fatality rates declined significantly. Advances in surgical and medical management, along with systems-based changes such as the emergence of neurocritical care units, are potential explanations for the reduced case-fatality.aSAH=aneurysmal subarachnoid hemorrhage; CI=confidence interval; GCNK=Greater Cincinnati/Northern Kentucky; GCS=Glasgow Coma Scale; ICD-9=International Classification of Diseases–9; ICH=intracerebral hemorrhage; ICU=intensive care unit; mRS=modified Rankin Scale; SAH=subarachnoid hemorrhage