title: The spectrum of management practices in nontraumatic subarachnoid hemorrhage: A survey of high-volume centers in the United States.
abstract: BACKGROUND
  There is a considerable variety of management practices for nontraumatic subarachnoid hemorrhage (ntSAH) across high-volume centers in the United States. We sought to design a survey which would highlight areas of controversy in the modern management of ntSAH and identify specific areas of interest fo further study.
  
  
  METHODS
  A questionnaire on management practices in ntSAH was formulated using a popular web-based survey tool (SurveyMonkey(™), Palo Alto, CA) and sent to endovascular neurointerventionists and cerebrovascular surgeons who manage a high volume of these patients annually. Two-hundred questionnaires were delivered electronically, and after a period of 2 months, the questionnaire was resent to nonresponders.
  
  
  RESULTS
  Seventy-three physicians responded, representing a cross-section of academic and other high-volume centers of excellence from around the country. On average, the responding interventionists in this survey each manage approximately 100 patients with ntSAH annually. Over 57% reported using steroids to treat this patient population. Approximately 18% of the respondents use intrathecal thrombolytics in ntSAH. Over 90% of responding physicians administer nimodipine to all patients with ntSAH. Over 40% selectively administer antiepileptic drugs to patients with ntSAH. Several additional questions were posed regarding the methods of detecting and treating vasospasm, as well as the indications for CSF diversion in patients with ntSAH further demonstrating the great diversity in management.
  
  
  CONCLUSIONS
  This survey illustrates the astonishing variety of treatment practices for patients with ntSAH and underscores the need for further study.
authors: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors: Luke
authors: L
authors: Tomycz
authors: Nakul
authors: N
authors: Shekhawat
authors: Jonathan
authors: J
authors: Forbes
authors: Mayshan
authors: M
authors: Ghiassi
authors: Mahan
authors: M
authors: Ghiassi
authors: Dennis
authors: D
authors: Lockney
authors: Dennis
authors: D
authors: Velez
authors: Robert
authors: R
authors: Mericle