‘Surprising’ regional variations in subarachnoid haemorrhage care revealed by Finnish study


A study recently published in the journal Neurology investigated whether there are discrepancies in the prognosis of subarachnoid haemorrhage (SAH) patients between the university hospital districts in Finland—and has revealed “surprising” regional differences, according to lead author Aleksanteri Asikainen (University of Helsinki, Helsinki, Finland).

According to the study, Finland’s lowest SAH mortality figures were found in patients treated in Helsinki and Oulu, while the highest mortality rate was observed in Turku. During the study period, prognoses improved the most in Helsinki and Tampere. The difference between the highest and lowest mortality rates in the university hospital districts was 52%, and variations were similar for women and men in all age groups.

“The regional differences came as a surprise, as Finland has a relatively homogenous population with equal access to public hospital care,” said Asikainen. “Because of these regional differences, region-specific mortality rates should not [be] generalised as nationwide figures of Finland in international comparisons, as has usually occurred.”

The research dataset was composed of nearly 10,000 SAH cases from 1998 to 2017, including information on patients who died before receiving neurosurgical care.

In Finland, the treatment of SAH patients has been centralised in five university hospitals—Helsinki University Hospital, Tampere University Hospital, Turku University Hospital, Oulu University Hospital and Kuopio University Hospital.

In an international comparison, the hospital mortality rate of all SAH patients in Finland was 20%, while the corresponding figure for the Helsinki University Hospital region was less than 17% at the end of the study period. In Norway, the UK and Australia, these figures have been roughly 25% in nationwide studies.

“Our findings indicate the unit in the former Töölö Hospital, headed by neurosurgeons and neuroanaesthesiologists, ultimately achieved the lowest SAH mortality rate in Finland, and one of the lowest globally,” said Miikka Korja (University of Helsinki, Helsinki, Finland). “Now that the treatment of SAH patients has been transferred to the new Meilahti Bridge Hospital, we must carefully monitor mortality figures.”

According to the researchers, their data cannot be used to explain differences in mortality between hospitals. Consequently, the research findings should not be used as indicators of the quality of care at the university hospitals.

“The mortality figures understandably appear to be the lowest in hospitals that provide care to the highest number of patients as well as to patients with the lowest average age,” added principal author Ilari Rautalin (Auckland University of Technology, Auckland, New Zealand). “To determine more specific reasons, we need research that encompasses more extensive information on individual risk factors, as well as differences between hospitals in the diagnostics and treatment of SAH patients.”


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