Evidence map›Paper›PMID 40828346›Full record

Observational studyNeurosurgical review2025

Geographical accessibility and case loads in subarachnoid hemorrhage care: a nationwide study of German hospitals.

Nazife Dinc, Christiane von Sass, Sergio Calero-Martinez, Sae-Yeon Won, Daniel Dubinski, Joachim Bergmann, Larissa Fink, Jil Adelstein, Florian Ebner, Hans-Jakob Steiger and 2 more

Abstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in Neurosurgical review, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Nazife DincDepartment of Neurosurgery, Jena University Hospital, Jena, Germany. Nazife.Dinc@med.uni-jena.de.
Christiane von SassCentre for Palliative and Neuro-palliative Care, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Berlin, Germany.
Sergio Calero-MartinezDepartment of Neurosurgery, Jena University Hospital, Jena, Germany.
Sae-Yeon WonDepartment of Neurosurgery, University Medicine Rostock, Rostock, Germany.
Daniel DubinskiDepartment of Neurosurgery, University Medicine Rostock, Rostock, Germany.
Joachim BergmannTrinovis GmbH, Hannover, Germany.
Larissa FinkCentre for Palliative and Neuro-palliative Care, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Berlin, Germany.
Jil AdelsteinTrinovis GmbH, Hannover, Germany.
Florian EbnerDepartment of Neurosurgery, Alfried Krupp Hospital, Essen-Rüttenscheid, Germany.
Hans-Jakob SteigerDepartment of Neurosurgery, Düsseldorf University Hospital, Düsseldorf, Germany.
Christian A SenftDepartment of Neurosurgery, Jena University Hospital, Jena, Germany.
Marcel A KampCentre for Palliative and Neuro-palliative Care, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Berlin, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

This observational cross-sectional study aims to investigate the accessibility of German hospitals in the event of an aneurysmal subarachnoid hemorrhage (SAH). Specifically, it analyzes the average travel time to hospitals of varying care levels (level 2 = advanced, level 3 = comprehensive), defined as facilities equipped with neurosurgical and/or neurointerventional treatment capacities essential for SAH management, and examines the role of university hospitals in SAH management. Furthermore, the association between accessibility and socioeconomic deprivation will be evaluated. Data from all German hospital cases in 2022 were analyzed, based on Section 136b of the Social Code Book V as outlined by the G-BA. Hospital infrastructure and accessibility metrics were sourced from the trinovis VISION platform (trinovis GmbH, Hannover, Germany) using the tools "hospitals" and "accessibility". A total of 7,855 SAH cases were treated in 794 hospitals across Germany. Among these, 27.3% of hospitals provided extended emergency care (treating 1,249 cases), and 19.6% offered comprehensive care (treating 4,279 cases). In total, 78,576 cerebral angiographies and 4,929 selective embolizations were performed. The average travel time to an SAH-capable hospital was 13.6 minutes, with 97% of the population within a 60-minute reach. A significant correlation was found between geographic accessibility and socioeconomic deprivation, with more deprived areas experiencing longer travel times. This cross-sectional study highlights disparities in access to aneurysmal SAH care across Germany. The findings demonstrate that while most of the population lives within a 60-minute travel time to appropriate hospitals, individuals in socioeconomically deprived areas face longer travel times and potentially reduced access to timely, specialized care. Given the high prehospital mortality associated with SAH, these accessibility gaps may contribute to worse outcomes in disadvantaged regions. To improve equity in emergency neurosurgical care, targeted political and structural interventions are required - especially for underserved populations in geographically and socioeconomically isolated areas.

Indexed as

Health Services AccessibilitySubarachnoid HemorrhageAdultAgedCross-Sectional StudiesFemaleGermanyHospitalsHumansMaleMiddle AgedSocioeconomic FactorsAneurysmal subarachnoid hemorrhageGeographical reachabilityHospital accessibilitySocioeconomic deprivation

Identifiers

PMID40828346

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.