title: Is this subarachnoid hemorrhage significant? A National Survey of Neurosurgeons.
abstract: BACKGROUND
  Previously all subarachnoid hemorrhage (SAH) patients were admitted, whereas now patients with angiography may be discharged.
  
  
  OBJECTIVE
  To survey neurosurgeons to determine current practice and what constitutes a clinically significant subarachnoid hemorrhage.
  
  
  METHODS
  We surveyed all neurosurgeons listed in the Canadian Medical Directory. We used a modified Dillman technique with up to five mailed surveys plus a pre-notification letter. Neurosurgeons rated the significance of 13 scenarios of subarachnoid hemorrhage. Scenarios varied from aneurysmal subarachnoid hemorrhage to patients with isolated xanthochromia in cerebrospinal fluid. Each scenario was rated for clinical significance using a 5-point scale [1(always) to 5(never)].
  
  
  RESULTS
  Of the 224 surveyed, 115 neurosurgeons responded. Scenarios with aneurysms requiring intervention, arteriovenous malformations, death or any surgical intervention all had median responses of 1 (IQR 1, 1). Scenarios having xanthochromia and few red blood cells in cerebrospinal fluid with negative computerized tomogram (CT) and angiography had median responses of 3 (IQR 1, 4). Scenarios with perimesencephalic pattern on CT with negative angiography had median of 3 (IQR 2, 4). Scenarios where patient is discharged from the emergency department had median of 4 (IQR 3, 5).
  
  
  CONCLUSIONS
  Subarachnoid hemorrhages due to aneurysms or arteriovenous malformations causing death or requiring surgical intervention are always clinically significant. Other types of nonaneurysmal subarachnoid hemorrhages had inconsistent ratings for clinical significance. These survey results highlight the need for further discussions to standardize the diagnosis of what constitutes a clinically significant subarachnoid hemorrhage and what care should be afforded to these patients.
authors.affiliation: Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Perry
authors.forename: Cheryl
authors.initials: C
authors.lastname: Symington
authors.forename: Marlène
authors.initials: M
authors.lastname: Mansour
authors.forename: Monica
authors.initials: M
authors.lastname: Taljaard
authors.forename: Ian G
authors.initials: IG
authors.lastname: Stiell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D002170:Canada; D002533:Cerebral Angiography; D016001:Confidence Intervals; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000523:psychology*; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed