European Stroke Organisation Conference: Abstracts

Background and Aims: Differences in outcome among different settings are common in many diseases and may reflect differences in quality of care.We aimed to quantify between-center and between-country differences in outcome after aneurysmal subarachnoid hemorrhage (aSAH).Method: We analyzed data from 5530 aSAH patients from three randomized clinical trials including 170 centers and 22 countries.We used random-effects logistic regression adjusted for patient characteristics to estimate between-center and between-country differences in unfavorable outcome, defined as Glasgow Outcome Scale 1-3 (severe disability, vegetative state or death) or modified Rankin Scale 4-6 (moderately severe disability, severe disability or death) at three months.Between-center and between-country differences were quantified with the median odds ratio (MOR), which is based on the variance of the random effects and can be interpreted as the odds ratio for unfavorable outcome between two randomly selected centers or countries.We analyzed the total database and performed subgroup analysis stratified for continent (Europe, North America and Oceania).Results: The proportion of patients with unfavorable outcome was 27%.We found substantial between-center differences (MOR ¼ 1.26), which were not explained by patient characteristics (adjusted MOR ¼ 1.30).Between-country differences were also found (adjusted MOR ¼ 1.41).Between-center differences were absent in Oceania and North America (adjusted MOR ¼ 1.00), but were present in Europe (adjusted MOR ¼ 1.51).Conclusion: Outcome after aSAH differs between centers and countries, especially in Europe.Since these differences could not be explained by patient characteristics, future research should focus on explanations regarding differential treatment policies and quality of care.