Scientific Letter
Current situation and characteristics of centers specialized in management of aneurysmal subarachnoid hemorrhage in Spain
Situación actual y características de los centros especializados en el manejo de la hemorragia subaracnoidea aneurismática en España
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A: Timing of treatment; B: type of treatment; C: clipping; E: embolization.</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Bar chart where height represents the % of centers of the total participating in the study.</span></p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Of the different cerebrovascular accidents, non-traumatic subarachnoid hemorrhage (SAH) is considered to be the least common presentation, representing 5%–10% of all cases. In Spain, the incidence ranges between 4.2 and 5.7 cases per 100,000 inhabitants and year, depending on the source.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Spontaneous subarachnoid hemorrhage is characterized by high morbidity and mortality. The most recent studies at the national level report a mortality rate of 24%–27%.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> The disorder poses an important sociosanitary problem since the affected individuals are typically young, previously healthy, during working age. The years of potential productive life lost are estimated to be similar to those recorded in intracranial hemorrhage or ischemic stroke.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Due to the complexity of the management of the disease, different international guides underscore the need for close and continuous monitoring of patients with SAH, mainly in Intensive Care Units (ICUs) belonging to tertiary hospitals with multidisciplinary teams and a large volume of patients (>35 patients/year).<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> This has been shown to reduce mortality and complications that can have an impact on patient quality of life.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Within the Spontaneous Subarachnoid Hemorrhage Registry (REMOS study), a survey has been carried out to know the current situation and characteristics of the centers specialized in the management of SAH in Spain. An invitation to participate was sent by e-mail to the members of the Neurointensive and Trauma Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), which currently has 369 members from 96 centers throughout the country. This same Working Group had already surveyed patients with cerebrovascular disease, but collected different data.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> No Ethics Committee approval was requested, given the voluntary and anonymous nature of the participation and the absence of patient-related data. The survey was open from October 2021 to July 2023, the initially entered data were corroborated at the end of the period. The survey is available as Supplementary material (Supplementary material 1).</p><p id="par0025" class="elsevierStylePara elsevierViewall">The present study analyzes the data obtained from the survey. A descriptive statistical analysis was made and data was reported as number (percentage) or median (interquartile range [IQR]). The response rate was calculated concerning the number of centers represented within the Working Group. In the case of duplicate responses, these were reviewed and, in the event of discrepancies between them, the authors were contacted for clarification.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A total of 56 responses were received, and after removing duplicates, we included information corresponding to 48 hospitals from all over Spain, representing a response rate of 50% (Supplementary material 2). The most extensively represented regions were the Community of Madrid (10 hospitals) and Catalonia (7 hospitals). These were followed by the Valencian Community, Andalusia and Castilla y León, with 5 hospitals each (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The vast majority (98%) were public hospitals.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">A little over half of the collaborating centers (52.1%) have more than 800 hospital beds, 33.3% have 500–800 beds, and 14.6% have less than 500 beds. The median number of ICU beds in the participating centers was 30 (IQR 23–39); 10.5% of the centers had 50 or more ICU beds.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Patients with SAH were mainly admitted to polyvalent ICUs (in 70.8% of the centers) or neurotrauma ICUs (22.9%). The annual number of admissions of patients with SAH was less than 25 in 14.6% of the centers, 25–50 in 39.6%, 50–75 in 25%, and over 75 in 20.8%.</p><p id="par0045" class="elsevierStylePara elsevierViewall">With regard to the availability of neurosurgeons in the corresponding centers, 64.6% of the hospitals had at least one neurosurgeon present 24 h a day, while in the rest of the centers, neurosurgeon was on-call from home after 3:00 pm. On the other hand, the interventional neuroradiologist was present from 8:00 am to 3:00 pm, followed by on-call duty, in 81.3% of the centers, while in 10% of the centers this specialist was only present from 8:00 am to 3:00 pm. Only 8.3% of the centers had an interventional radiologist present on an uninterrupted basis.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Exclusion of the aneurysm was performed in the first 72 h in all the centers. In one-half of the hospitals it was carried out on a scheduled basis in the morning hours, and sometimes also in the course of duty during the afternoon. In 23% of the centers, exclusion was performed on an urgent basis, while in 18.8% it was carried out on a scheduled basis in the morning hours. Four hospitals reported other treatment periods: scheduled or urgent intervention on weekends, in some cases urgent and in others scheduled on the following morning, usually urgent except during nighttime hours, and also at night depending on the type of SAH (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). With regard to the type of treatment, 81.3% of the hospitals performed endovascular treatment three times more often than surgical treatment (clipping 25%/embolization 75%) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The data obtained from the survey describe the hospitals and the ICUs that treat these patients and also the most common types of aneurysmal treatment used. These latter data are consistent with those previously published by the Working Group and the Spanish Society of Neurosurgery.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial support</span><p id="par0065" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Financial support" ] 2 => array:2 [ "identificador" => "xack754610" "titulo" => "Acknowledgements" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0080" class="elsevierStylePara elsevierViewall">The following are Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0020" ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1510 "Ancho" => 2091 "Tamanyo" => 111760 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Number of participating centers according to regions.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1079 "Ancho" => 2341 "Tamanyo" => 117545 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Treatment of SAH in the different centers. A: Timing of treatment; B: type of treatment; C: clipping; E: embolization.</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Bar chart where height represents the % of centers of the total participating in the study.</span></p>" ] ] 2 => array:6 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 173604 ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Survey.</p>" ] ] 3 => array:6 [ "identificador" => "upi0010" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc2.pdf" "ficheroTamanyo" => 420230 ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">List of collaborating centers.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Proyecto EHSA: estudio de hemorragias subaracnoideas espontáneas en Andalucía. 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