Abstract P48: Factors Associated With Delay to Treatment of Aneurysmal Subarachnoid Hemorrhage (aSAH) - A Systematic Review

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Thuy Phuong Nguyen ◽  
Sabah Rehman ◽  
Christine Stirling ◽  
Ronil V Chandra ◽  
Linda Nichols ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Delay ◽  
Definitive Treatment ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Time Duration ◽  
Time Intervals ◽  
Time To Treatment ◽  
Factors Associated ◽  
Hospital Factors ◽  
Delay In Treatment

Background: Delay in treatment of aneurysmal subarachnoid haemorrhage (aSAH) appears to be common, contributing to the poor outcomes of patients. We currently have limited understanding of the causes of these delays. The aim of this systematic review was to identify delays in treatment of patients with aSAH, and to identify factors associated with treatment delay. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. We searched four electronic databases (MEDLINE, EMBASE, Web of Science, and Google Scholar) for manuscripts published from January 1998 to 2020 using pre-designated search terms and search strategy. Main outcomes were duration of delays of any time intervals from onset of aSAH to definitive treatment and/or factors related to delays. Results: A total of 64 studies met study entry criteria. We identified 16 different time intervals in the pathway of aSAH patients and 17 groups of predictors to delay in treatment. Most studies measured time intervals between four major time points including time of onset, hospital admission, diagnosis, and receiving coiling or clipping. Methods to measure delay in treatment varied largely between studies, using cut-off timepoints or measured absolute time duration using mean or median. Demographic factors (age, sex, race, or socioeconomic status) were not associated with time to treatment. More severe aSAH reduced treatment delay in most studies. Pre-hospital delays (patients delay, late referral, late arrival of ambulance, being transferred between hospitals or arriving at the hospital outside of office hours) were associated with treatment delay. In-hospital factors (complication, having other procedures before definitive treatment, and type of treatment) had two-way association with treatment delay - both increasing and decreasing time to treatment. Conclusions: This review provides the first comprehensive understanding of types and predictors of delays in treatment of aSAH. There is significant opportunity to increase the comparability of aSAH time to treatment data, and to identify pre-hospital and in-hospital factors that currently delay treatment.

Time and predictors of time to treatment for aneurysmal subarachnoid haemorrhage (aSAH): a systematic review

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Thuy Phuong nguyen ◽  
Sabah Rehman ◽  
Christine Stirling ◽  
Ronil Chandra ◽  
Seana Gall
Keyword(s):  
Systematic Review ◽  
Subarachnoid Haemorrhage ◽  
Meta Analysis ◽  
Treatment Delay ◽  
Definitive Treatment ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Time Intervals ◽  
Time To Treatment ◽  
Factors Associated ◽  
Modifiable Factors

Abstract Background Aneurysmal subarachnoid haemorrhage (aSAH) is a serious form of stroke, for which rapid access to specialist neurocritical care is associated with better outcomes. Delays in the treatment of aSAH appear to be common and may contribute to poor outcomes. We have a limited understanding of the extent and causes of these delays, which hinders the development of interventions to reduce delays and improve outcomes. The aim of this systematic review was to quantify and identify factors associated with time to treatment in aSAH. Methods This systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and was registered in PROSPERO (Reg. No. CRD42019132748). We searched four electronic databases (MEDLINE, EMBASE, Web of Science and Google Scholar) for manuscripts published from January 1998 using pre-designated search terms and search strategy. Main outcomes were duration of delays of time intervals from onset of aSAH to definitive treatment and/or factors related to time to treatment. Results A total of 64 studies with 16 different time intervals in the pathway of aSAH patients were identified. Measures of time to treatment varied between studies (e.g. cut-off timepoints or absolute mean/median duration). Factors associated with time to treatment fell into two categories—individual (n = 9 factors, e.g. age, sex and clinical characteristics) and health system (n = 8 factors, e.g. pre-hospital delay or presentation out-of-hours). Demographic factors were not associated with time to treatment. More severe aSAH reduced treatment delay in most studies. Pre-hospital delays (patients delay, late referral, late arrival of ambulance, being transferred between hospitals or arriving at the hospital outside of office hours) were associated with treatment delay. In-hospital factors (patients with complications, procedure before definitive treatment, slow work-up and type of treatment) were less associated with treatment delay. Conclusions The pathway from onset to definitive treatment of patients with aSAH consists of multiple stages with multiple influencing factors. This review provides the first comprehensive understanding of extent and factors associated with time to treatment of aSAH. There is an opportunity to target modifiable factors to reduce time to treatment, but further research considering more factors are needed.

scholarly journals FACTORS ASSOCIATED WITH DELAY IN CANCER DIAGNOSIS AND TREATMENT IN CHILDREN, A STUDY FROM NORTHERN PAKISTAN.

2019 ◽  
Vol 26 (07) ◽  
pp. 1156-1161
Author(s):  
Tanveer Ashraf ◽  
Shoaib Ahmed ◽  
Saman Tanveer
Keyword(s):  
Time Lag ◽  
Healthcare Facility ◽  
Treatment Delay ◽  
Patient Delay ◽  
Definitive Treatment ◽  
Military Hospital ◽  
Malignant Diseases ◽  
Total Delay ◽  
Cross Sectional ◽  
Factors Associated

Objectives: This study explores various factors responsible for delay in management of Pakistani children having malignant diseases. Study Design: Cross-sectional, observational study. Setting: Pediatric Oncology Unit of Combined Military Hospital Rawalpindi. Period: 1st March 2017 to 31st August 2017. Material and Methods: A total of 147 children, up to 15 years of age, being managed for malignant diseases were enrolled. Data was collected by reviewing the medical record and face-to-face interviews of the parents. Time lag from onset of symptoms to start of treatment was divided in three categories, patient delay, physician delay and treatment delay. Various factors associated with delay were analyzed. Results: Out of 147 patients, 114 were male and 33 were female. Mean age was 5.76 (±SD 3.15) years. Mean patient delay was 13.36 (+ SD 27.21) days. Mean physician delay was 66.22 (+ SD 87.66) days and mean treatment delay was 17.61 (+ SD 46.20) days. In 34% of patients total delay was > 90 days. Important factors associated with delay were age of patient, type of malignancy, financial problems, distance from healthcare facility, parents’ education status, their perception about usefulness of treatment and use of alternative therapies. Patients’ gender was not significantly associated with delayed management. Discussion & Conclusion: One third of our patients had to wait for three months or more for definitive treatment to start. Physician delay was more than patient or treatment delay. It signifies that our health care system is not well equipped to promptly handle malignant diseases in children. Better training of medical professionals and improvement in diagnostic facilities can result in reduced time lag before definite treatment.

scholarly journals A systematic review of the factors associated with the course of borderline personality disorder symptoms in adolescence

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Gabriele Skabeikyte ◽  
Rasa Barkauskiene
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Strong Support ◽  
Borderline Personality ◽  
Developmental Pathways ◽  
Eligibility Criteria ◽  
Factors Associated ◽  
Prospective Longitudinal

Abstract Background Research on personality pathology in adolescence has accelerated during the last decade. Among all of the personality disorders, there is strong support for the validity of borderline personality disorder (BPD) diagnosis in adolescence with comparable stability as seen in adulthood. Researchers have put much effort in the analysis of the developmental pathways and etiology of the disorder and currently are relocating their attention to the identification of the possible risk factors associated with the course of BPD symptoms during adolescence. The risk profile provided in previous systematic reviews did not address the possible development and course of BPD features across time. Having this in mind, the purpose of this systematic review is to identify the factors that are associated with the course of BPD symptoms during adolescence. Methods Electronic databases were systematically searched for prospective longitudinal studies with at least two assessments of BPD as an outcome of the examined risk factors. A total number of 14 articles from the period of almost 40 years were identified as fitting the eligibility criteria. Conclusions Factors associated with the course of BPD symptoms include childhood temperament, comorbid psychopathology, and current interpersonal experiences. The current review adds up to the knowledge base about factors that are associated with the persistence or worsening of BPD symptoms in adolescence, describing the factors congruent to different developmental periods.

scholarly journals Systematic Review and Meta-Analysis of the Dose-Response and Risk Factors for Obliteration of Arteriovenous Malformations Following Radiosurgery: An Update Based on the Last 20 Years of Published Clinical Evidence

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Shaoyu Zhu ◽  
N Patrik Brodin ◽  
Madhur K Garg ◽  
Patrick A LaSala ◽  
Wolfgang A Tomé
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Dose Response ◽  
Meta Analysis ◽  
Gamma Knife Radiosurgery ◽  
Lesion Size ◽  
Intracranial Arteriovenous Malformation ◽  
Factors Associated ◽  
Obliteration Rate ◽  
Inverse Variance

ABSTRACT BACKGROUND Intracranial arteriovenous malformation (AVM) is a congenital lesion that can potentially lead to devastating consequences if not treated. Many institutional cohort studies have reported on the outcomes after radiosurgery and factors associated with successful obliteration in the last few decades. OBJECTIVE To quantitatively assess the dose-response relationship and risk factors associated with AVM obliteration using a systematic review and meta-analysis approach. METHODS Data were extracted from reports published within the last 20 yr. The dose-response fit for obliteration as a function of marginal dose was performed using inverse-variance weighting. Risk factors for AVM obliteration were assessed by combining odds ratios from individual studies using inverse-variance weighting. RESULTS The logistic model fit showed a clear association between higher marginal dose and higher rates of obliteration. There appeared to be a difference in the steepness in dose-response when comparing studies with patients treated using Gamma Knife radiosurgery (Elekta), compared to linear accelerators (LINACs), and when stratifying studies based on the size of treated AVMs. In the risk-factor analysis, AVM obliteration rate decreases with larger AVM volume or AVM diameter, higher AVM score or Spetzler-Martin (SM) grade, and prior embolization, and increases with compact AVM nidus. No statistically significant associations were found between obliteration rate and age, sex, prior hemorrhage, prior aneurysm, and location eloquence. CONCLUSION A marginal dose above 18 Gy was generally associated with AVM obliteration rates greater than 60%, although lesion size, AVM score, SM grade, prior embolization, and nidus compactness all have significant impact on AVM obliteration rate.

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