• Maud A Tjerkstra, Dagmar Verbaan, Bert A Coert, René Post, René van den Berg, Jonathan M Coutinho, Janneke Horn, and W Peter Vandertop.
• Department of Neurosurgery, Amsterdam Neurosciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands. Electronic address: m.a.tjerkstra@amsterdamumc.nl.
• World Neurosurg. 2022 Apr 1; 160: e412-e420.

BackgroundDelayed cerebral ischemia (DCI) contributes to poor outcomes after subarachnoid hemorrhage (SAH). The pathophysiology of DCI is not fully understood, which has hindered the adoption of a uniform definition. Furthermore, a reliable diagnostic test and an effective evidence-based treatment are lacking. This could lead to variations in care.MethodsA web-based survey on the variations in the definition, diagnosis, and treatment of DCI was designed and sent to 314 intensivists, neurologists, and neurosurgeons of all 9 hospitals in the Netherlands who care for patients with SAH. The responders were categorized into physicians responsible for the coordination of SAH care and those who were not. For questions on the definition and diagnosis, only the responses from the coordinating physicians were evaluated. For the treatment questions, all the responses were evaluated.ResultsThe response rate was 34% (106 of 314). All 9 hospitals were represented. Of the responses, 27 did not provide answers for the definition, diagnosis, or treatment questions; 79 responses were used for analysis. Signs of vasospasm were required by 21 of the 47 coordinating physicians (44%) when considering DCI. Of the 47 coordinating physicians, 24 (51%) did not use a diagnostic test results for a positive diagnosis of DCI. When patients were discharged within 21 days, 33 of the 73 responders (45%) did not provide a prescription for nimodipine continuation. Finally, all but one hospital had treated DCI with hypertension induction.ConclusionsWe found large variations in the definition, diagnosis, and treatment of DCI in the Netherlands. In the absence of evidence-based treatment, standardization of management seems warranted in an effort to optimize DCI care.Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

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