Nav: Home

Current tools have low accuracy for predicting delayed ischemia after aneurysmal subarachnoid hemorrhage

February 21, 2019

February 21, 2019 - Both CT angiography and transcranial Doppler have limited accuracy in detecting cerebral vasospasm and predicting delayed cerebral ischemia (DCI) in patients with subarachnoid hemorrhage (SAH) due to ruptured aneurysm, reports a study in the inaugural edition of Critical Care Explorations, the official open-access journal of the Society of Critical Care Medicine (SCCM). The journal is published in the Lippincott portfolio by Wolters Kluwer.

"Cerebral vasospasm is frequently present on CT angiography and transcranial Doppler, lacking accurate prediction of DCI or unfavorable outcome after six months," according to the report by J. Joep van der Harst, MD, and colleagues of University of Groningen, The Netherlands. The paper is among the first to be published in the new open-access journal Critical Care Explorations (CCE), which will premiere at SCCM's 48th Critical Care Congress, opening today at the San Diego Convention Center. Designed to complement SCCM's flagship journals Critical Care Medicine (CCM) and Pediatric Critical Care Medicine (PCCM), CCE provides additional articles and information that encompass the broad scope of critical care.

Study Compares Two Screening Tests for Cerebral Vasospasm after SAH

The prospective study included 59 patients with aneurysmal SAH treated at the authors' neurocritical care unit and neurosurgical ward between 2013 and 2016. At five and ten days, the patients underwent both CT angiography and transcranial Doppler.

The study is the first to directly compare the diagnostic performance of the two tests, which are commonly used for early detection of cerebrovascular spasm (CVS) to detect the "dreaded secondary complication" of DCI. "The optimal screening modality for detecting symptomatic CVS is a matter of debate," the researchers write. (They also note that the causative role of CVS is unproven.)

On both days, CT angiography showed CVS in at least one vessel in nearly all patients. In contrast, transcranial Doppler showed CVS in less than half of patients. Agreement between the two tests was just 0.47.

Sixteen patients had DCI, while 12 patients had unfavorable outcomes at six months. CT angiography was highly sensitive in predicting DCI for prediction of DCI, but it had "extremely low" specificity compared to transcranial Doppler. On day five, accuracy in predicting unfavorable outcomes was 61 percent with transcranial Doppler versus 27 percent with CT angiography.

The results suggest that CVS after aneurysmal SAH is a common finding, and that neither test is an accurate predictor of DCI or unfavorable outcome. "Our study does not support a prominent role of screening with TCD or CTA," Dr. van der Harst and coauthors conclude. "Detection of CVS that does not become clinically manifest likely leads to overtreatment and prolonged hospital stay."

Critical Care Explorations Debuts at the 48th Critical Care Congress 2019

"This prospective study on pressing clinical question is an excellent example of the discovery-centric, evidence-based focus of our new open-access journal," comments CCE Editor-in-Chief, Timothy G. Buchman, PhD, MD,

MCCM, from Emory University in Atlanta, Georgia. "The open-access journal offers especially timely review, quick publication, and global dissemination of new ideas and syntheses that practitioners can bring to the bedside."

Critical Care Explorations is designed to facilitate rapid communication of innovations and new information with the potential to influence critical care research and practice. It features a prestigious international Editorial Board with the same rigorous peer-review process as CCM and PCCM.

"As a fully open-access journal, CCE's content is available all the time and is truly global, offering greater opportunities for exploring international perspectives on issues related to critical care," Dr. Buchman adds. Also available to read now are an introductory editorial, describing the vision behind CCE and providing practical information on the submission and publication process; as well asas well as a tribute to the late Vladimir ('Vlad') Kvetan, MD, FCCM, renowned for his leadership of Disaster Medicine and for the innovative concept of the 'ICU Without Walls.'
Click here to read "Transcranial Doppler Versus CT-Angiography for Detection of Cerebral Vasospasm in Relation to Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage"

DOI: 10.1097/CCE.0000000000000001

Note to editors: For further information, contact Curtis Powell, Director of Marketing and Communications for SCCM: phone +1 847 827-7282 or +1 312 285-6551; or email

About the Society of Critical Care Medicine

The Society of Critical Care Medicine (SCCM) is the largest nonprofit medical organization dedicated to promoting excellence and consistency in the practice of critical care. With members in more than 100 countries, SCCM is the only organization that represents all professional components of the critical care team. The Society offers a variety of activities that ensures excellence in patient care, education, research, and advocacy. SCCM's mission is to secure the highest quality of care for all critically ill and injured patients. Visit for more information. Follow @SCCM or visit us on Facebook.

About Wolters Kluwer

Wolters Kluwer is a global leader in professional information, software solutions, and services for the health, tax & accounting, finance, risk & compliance, and legal sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.

Wolters Kluwer, headquartered in the Netherlands, reported 2017 annual revenues of €4.4 billion. The company serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,000 people worldwide.

Wolters Kluwer Health is a leading global provider of trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students with advanced clinical decision support, learning and research and clinical intelligence. For more information about our solutions, visit and follow us on LinkedIn and Twitter @WKHealth.

Wolters Kluwer Health

Related Critical Care Articles:

Harvard Medical School expert calls for protection of critical gains made in cancer care under ACA
As the White House moves forward with its efforts to repeal Obamacare, it should strive to preserve -- and further boost -- these important advances, according to an introduction penned by Harvard Medical School professor health care policy expert Nancy Keating, who served as guest editor for the issue.
SAEM 2017: EM physicians should stay current on studies to up their critical care game
Reviewing studies can be a tedious task, but one Michigan Medicine physician explains the importance of staying up to date on medical literature, even outside of one's primary field of medicine.
Video messages clarify patients' wishes for critical versus end-of-life care
Adding a patient-created video testimonial to a living will or 'POLST' form can help to prevent errors of interpretation regarding the choice between life-sustaining treatment or allowing natural death in critically ill patients, according to a study in the March Journal of Patient Safety.
Primary care physician involvement at end of life associated with less costly, less intensive care
A new study published in the January/February issue of Annals of Family Medicine finds that primary care physician involvement at the end of life is associated with less costly and less intensive end-of-life care.
Genomic data sharing is critical to improving genetic health care
ACMG tackles the question of how to make sense of the massive amount of genetic information being generated for better patient care in a new statement, 'Laboratory and Clinical Genomics Data Sharing is Crucial to Improving Genetic Health Care.' Genomic Data Sharing is critical to improving healthcare says ACMG's new position statement.
Critical zone, critical research
The critical zone extends from the top of the tallest tree down through the soil and into the water and rock beneath it.
Patients not attached to new primary care practices receive lower quality care
One in six patients in Ontario does not belong to an organized primary care practice, new research suggests.
OPTIMISTIC study: Advance care planning in nursing homes challenging but critical
New research from the OPTIMISTIC project shows critical need for advance care planning and highlights challenges that healthcare institutions -- especially nursing homes -- face in supporting high quality advance care planning.
Young people aging out of foster care may be leaving behind critical healthcare coverage
States are required to provide health insurance to young people who have aged out of the foster care system until their 26th birthday.
Map the gap: The geography of critical care medicine training programs and sepsis mortality
A study from Advocate Christ Medical Center in Oak Lawn, Illinois, studied the relation of death from sepsis by geographic region with the location of critical care fellowship training programs.

Related Critical Care Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Failure can feel lonely and final. But can we learn from failure, even reframe it, to feel more like a temporary setback? This hour, TED speakers on changing a crushing defeat into a stepping stone. Guests include entrepreneur Leticia Gasca, psychology professor Alison Ledgerwood, astronomer Phil Plait, former professional athlete Charly Haversat, and UPS training manager Jon Bowers.
Now Playing: Science for the People

#524 The Human Network
What does a network of humans look like and how does it work? How does information spread? How do decisions and opinions spread? What gets distorted as it moves through the network and why? This week we dig into the ins and outs of human networks with Matthew Jackson, Professor of Economics at Stanford University and author of the book "The Human Network: How Your Social Position Determines Your Power, Beliefs, and Behaviours".