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  • Institution of a Pharmacologic Prophylaxis Protocol is Correlated with a Reduction in Symptomatic Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

    Final Number:
    1082

    Authors:
    William Ares BS; Jordan K. Smith BS; Travis Michael Dumont MD; Michael Horgan MD; Bruce I. Tranmer MD, FACS, FRCS(C)

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2011 Annual Meeting

    Introduction: Cerebral vasospasm is a major contributor to morbidity and mortality following aneurysm rupture and subarachnoid hemorrhage. In June 2006, the neurosurgery department at UVM initiated institutional guidelines based on results of randomized trials requiring vasospasm prophylaxis with magnesium and pravastatin in addition to the existing practice of nimodipine dosing for all patients following aneurysm rupture. This is a retrospective study analyzing the efficacy of a structured prophylactic medication regiment in decreasing the incidence of cerebral vasospasm in a population of patients with aneurysmal SAH.

    Methods: All patients admitted to a single academic medical center between 2000 and 2011 with confirmed aneurysmal subarachnoid hemorrhage were included in this study. The patient cohort was sorted into two groups based on presentation before (n=113) or after (n=95) initiation of new institutional guidelines regarding the use of vasospasm prophylaxis. Outcomes were based on incidence of delayed ischemic neurologic deficit with correlated angiographic vasospasm.

    Results: Presence of clinical vasospasm was found to be significantly more common in the pre-guidelines group (X2 = 16.79, p < 0.001). Those patients presenting to the neurosurgical service before institution of prophylaxis guidelines had a 36.2% rate of vasospasm while those presenting after guidelines were initiated had an 11.6% rate of vasospasm. This represents an absolute risk reduction of 24.7% and a relative risk reduction of 68.1%.

    Conclusions: Preliminary data presented here has shown that incidence of vasospasm decreased after initiation of a departmental pharmacologic prophylaxis protocol. This suggests that an evidence-based multi-modal approach to prophylaxis as a departmental policy may decrease the incidence of cerebral vasospasm in patients with aneurismal subarachnoid hemorrhage.

    Patient Care: This research can improve patient care by showing the potential value of standardizing patient care via the use of evidence based medicine.

    Learning Objectives: By the conclusion of this session participants should be able to discuss the benefits of initiation of departmental policies governing pharmacologic prophylaxis of post-aneurysmal subarachnoid hemorrhage.

    References:

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