Trends in case-fatality rates in hospitalized nontraumatic subarachnoid hemorrhage: results of a population-based study in Dijon, France, from 1985 to 2006.
BACKGROUND
Subarachnoid hemorrhage accounts for 2% to 5% of all strokes and is associated with high morbidity and mortality rates. Reports in the literature show that case-fatality rates vary with time and according to geographical area.


OBJECTIVE
The objective of the study was to evaluate the case-fatality rates in subarachnoid hemorrhage at 1 and 6 months and to determine trends in these rates over 22 years using a population-based registry.


METHODS
The Dijon Stroke Registry has enabled us to perform a comprehensive analysis of subarachnoid hemorrhage diagnosed in a population of >150 000 inhabitants hospitalized between 1985 and 2006 in the Dijon University Hospital, which has both a neurosurgery unit and a neuroradiology unit. Diagnosis was based on clinical and neuroimaging features and, when necessary, on lumbar puncture.


RESULTS
Case-fatality rates for hospitalized subarachnoid hemorrhages at 1 and 6 months were 15.59% (95% confidence interval [CI], 9.37-25.34) and 16.84% (95% CI, 10.33-26.78), respectively. From 1985 to 1995, case-fatality rates for SAH at 1 and 6 months were 17.1% (95% CI, 8.1-34.2) and 17.7% (95% CI, 9.6-31.3), whereas from 1996 to 2006, they were 20.2% (95% CI, 10.2-37.8) and 19.7% (95% CI, 11.1-33.6), respectively.


CONCLUSIONS
Case-fatality rates for hospitalized subarachnoid hemorrhages in this population-based study remained stable over 22 years, suggesting that this stroke subtype is still a very severe disease despite early management. Most deaths occurred during the first 30 days. Further work is necessary to evaluate levels of prehospital case-fatality in our population-based registry.
Biotti
Damien
D
Stroke Registry of Dijon (INSERM and Institut de Veille Sanitaire), University Hospital and Faculty of Medicine and Department of Neurology, Dijon, France.
Jacquin
Agnès
A
Boutarbouch
Mahjouba
M
Bousquet
Olivier
O
Durier
Jérôme
J
Ben Salem
Douraied
D
Salem
Douraïeb Ben
DB
Ricolfi
Frederic
F
Beaurain
Jacques
J
Osseby
Guy-Victor
GV
Moreau
Thibault
T
Giroud
Maurice
M
Béjot
Yannick
Y
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D017063:Outcome Assessment, Health Care / Q000379:methods; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000401:mortality*; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000401:mortality*; D015996:Survival Rate; D016896:Treatment Outcome