title: Proximity to the treating centre and outcomes following subarachnoid hemorrhage.
abstract: BACKGROUND
  In the management of subarachnoid hemorrhage (SAH), the potential for early complications and the centralization of limited resources often challenge the delivery of timely neurosurgical care. We sought to determine the impact of proximity to the accepting neurosurgical centre on outcomes following aneurysmal SAH.
  
  
  METHODS
  Using administrative data, we analyzed patients undergoing treatment for aneurysmal subarachnoid hemorrhage at neurosurgical centres in Ontario between 1995 and 2004. We compared mortality for patients receiving treatment at a centre in their county (in-county) versus those treated from outside counties (out-of-county). We also examined the impact of distance from the patient's residence to the treating centre.
  
  
  RESULTS
  The mortality rates were significantly lower for in-county versus out-of-county patients (23.5% vs. 27.6%, p=0.009). This advantage remained significant after adjusting for potential confounders (HR=0.84, p=0.01). The relationship between distance from the treating centre and mortality was biphasic. Under 300 km, mortality increased with increasing distance. Over 300 km, a survival benefit was observed.
  
  
  CONCLUSIONS
  Proximity to the treating neurosurgical centre impacts survival after aneurysmal SAH. These results have significant implications for the triage of these critically ill patients.
authors.affiliation: Division of Neurosurgery, University of Alberta, Edmonton, Alberta.
authors.forename: Cian J
authors.initials: CJ
authors.lastname: O'Kelly
authors.forename: Julian
authors.initials: J
authors.lastname: Spears
authors.forename: David
authors.initials: D
authors.lastname: Urbach
authors.forename: M Christopher
authors.initials: MC
authors.lastname: Wallace
mesh_terms: D016208:Databases, Factual / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006801:Humans; D038801:International Classification of Diseases; D009493:Neurosurgery / Q000379:methods*; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome