Surgery in intracerebral hemorrhage. The uncertainty continues
Primary intracerebral hemorrhage (ICH) accounts for 10% to 20% of stroke but carries the highest rates of mortality and morbidity of all stroke subtypes. Current treatment, however, is varied and haphazard. The most recent Cochrane systematic review refers to 4 prospective, randomized controlled tri...
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Veröffentlicht in: | Stroke (1970) 2000-10, Vol.31 (10), p.2511-2516 |
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creator | Fernandes, H M Gregson, B Siddique, S Mendelow, A D |
description | Primary intracerebral hemorrhage (ICH) accounts for 10% to 20% of stroke but carries the highest rates of mortality and morbidity of all stroke subtypes. Current treatment, however, is varied and haphazard. The most recent Cochrane systematic review refers to 4 prospective, randomized controlled trials. We present a further meta-analysis to include 3 new trials. In addition, we review the trials of Chen et al and McKissock et al and discuss aspects of their quality that, we believe, prevent their inclusion in modern day meta-analysis.
Literature databases and articles were searched from 1966 to October 1999. Using the end points of death and dependency, the results of the 7 identified randomized trials were expressed as odds ratios. All available data were then analyzed with meta-analysis techniques. Analysis of relevant subsets of trials was also carried out.
Meta-analysis of all 7 trials shows a trend toward a higher chance of death and dependency after surgery (OR 1.20; 95% CI 0.83 to 1.74). Meta-analysis was also carried out after exclusion of the Chen and McKissock trials for reasons discussed in the text. This meta-analysis suggests a benefit from surgery, with a reduction in the chances of death and dependency after surgical treatment by a factor of 0.63 (OR 0.63; 95% CI 0.35 to 1.14).
When meta-analysis is restricted to modern-day, post-CT, well-constructed, balanced trials, a trend for surgery to reduce the chances of death and dependency is found. Perhaps, then, in the modern era of CT, good neuroanesthesia, intensive care, and the operating microscope, surgery has a role in the treatment of supratentorial intracerebral hemorrhage. The results of a large, multicenter, randomized controlled trial are urgently needed, and the ongoing International Surgical Trial of Intracerebral Hemorrhage should fulfill this objective. |
doi_str_mv | 10.1161/01.STR.31.10.2511 |
format | Article |
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Literature databases and articles were searched from 1966 to October 1999. Using the end points of death and dependency, the results of the 7 identified randomized trials were expressed as odds ratios. All available data were then analyzed with meta-analysis techniques. Analysis of relevant subsets of trials was also carried out.
Meta-analysis of all 7 trials shows a trend toward a higher chance of death and dependency after surgery (OR 1.20; 95% CI 0.83 to 1.74). Meta-analysis was also carried out after exclusion of the Chen and McKissock trials for reasons discussed in the text. This meta-analysis suggests a benefit from surgery, with a reduction in the chances of death and dependency after surgical treatment by a factor of 0.63 (OR 0.63; 95% CI 0.35 to 1.14).
When meta-analysis is restricted to modern-day, post-CT, well-constructed, balanced trials, a trend for surgery to reduce the chances of death and dependency is found. Perhaps, then, in the modern era of CT, good neuroanesthesia, intensive care, and the operating microscope, surgery has a role in the treatment of supratentorial intracerebral hemorrhage. The results of a large, multicenter, randomized controlled trial are urgently needed, and the ongoing International Surgical Trial of Intracerebral Hemorrhage should fulfill this objective.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/01.STR.31.10.2511</identifier><identifier>PMID: 11022087</identifier><identifier>CODEN: SJCCA7</identifier><language>eng</language><publisher>United States: American Heart Association, Inc</publisher><subject>Cerebral Hemorrhage - diagnostic imaging ; Cerebral Hemorrhage - surgery ; Humans ; Neurosurgical Procedures - adverse effects ; Neurosurgical Procedures - mortality ; Neurosurgical Procedures - statistics & numerical data ; Odds Ratio ; Postoperative Complications - etiology ; Postoperative Complications - mortality ; Randomized Controlled Trials as Topic ; Risk Assessment ; Survival Rate ; Tomography, X-Ray Computed ; Treatment Outcome</subject><ispartof>Stroke (1970), 2000-10, Vol.31 (10), p.2511-2516</ispartof><rights>Copyright American Heart Association, Inc. Oct 2000</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c361t-e9caa1e4a1a9c86a258af4c88377839757df84b223dbe48a035a8e75fde768323</citedby><cites>FETCH-LOGICAL-c361t-e9caa1e4a1a9c86a258af4c88377839757df84b223dbe48a035a8e75fde768323</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11022087$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fernandes, H M</creatorcontrib><creatorcontrib>Gregson, B</creatorcontrib><creatorcontrib>Siddique, S</creatorcontrib><creatorcontrib>Mendelow, A D</creatorcontrib><title>Surgery in intracerebral hemorrhage. The uncertainty continues</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>Primary intracerebral hemorrhage (ICH) accounts for 10% to 20% of stroke but carries the highest rates of mortality and morbidity of all stroke subtypes. Current treatment, however, is varied and haphazard. The most recent Cochrane systematic review refers to 4 prospective, randomized controlled trials. We present a further meta-analysis to include 3 new trials. In addition, we review the trials of Chen et al and McKissock et al and discuss aspects of their quality that, we believe, prevent their inclusion in modern day meta-analysis.
Literature databases and articles were searched from 1966 to October 1999. Using the end points of death and dependency, the results of the 7 identified randomized trials were expressed as odds ratios. All available data were then analyzed with meta-analysis techniques. Analysis of relevant subsets of trials was also carried out.
Meta-analysis of all 7 trials shows a trend toward a higher chance of death and dependency after surgery (OR 1.20; 95% CI 0.83 to 1.74). Meta-analysis was also carried out after exclusion of the Chen and McKissock trials for reasons discussed in the text. This meta-analysis suggests a benefit from surgery, with a reduction in the chances of death and dependency after surgical treatment by a factor of 0.63 (OR 0.63; 95% CI 0.35 to 1.14).
When meta-analysis is restricted to modern-day, post-CT, well-constructed, balanced trials, a trend for surgery to reduce the chances of death and dependency is found. Perhaps, then, in the modern era of CT, good neuroanesthesia, intensive care, and the operating microscope, surgery has a role in the treatment of supratentorial intracerebral hemorrhage. The results of a large, multicenter, randomized controlled trial are urgently needed, and the ongoing International Surgical Trial of Intracerebral Hemorrhage should fulfill this objective.</description><subject>Cerebral Hemorrhage - diagnostic imaging</subject><subject>Cerebral Hemorrhage - surgery</subject><subject>Humans</subject><subject>Neurosurgical Procedures - adverse effects</subject><subject>Neurosurgical Procedures - mortality</subject><subject>Neurosurgical Procedures - statistics & numerical data</subject><subject>Odds Ratio</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - mortality</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Risk Assessment</subject><subject>Survival Rate</subject><subject>Tomography, X-Ray Computed</subject><subject>Treatment Outcome</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkE9Lw0AQxRdRbK1-AC8SPHhL3NnNZjcXQYr_oCDYel42m0mbkiZ1Nzn027uhBUEYGHjzmzfDI-QWaAKQwSOFZLn6SjgkQWEC4IxMQbA0TjOmzsmUUp7HLM3zCbnyfkspZVyJSzIBoIxRJafkaTm4NbpDVLehemcsOiycaaIN7jrnNmaNSbTaYDS0YdSbAB0i27V93Q7or8lFZRqPN6c-I9-vL6v5e7z4fPuYPy9iyzPoY8ytMYCpAZNblRkmlKlSqxSXUvFcCllWKi0Y42WBqTKUC6NQiqpEmSnO-Iw8HH33rvsJd3u9q73FpjEtdoPXknHIhYIA3v8Dt93g2vCbhjzc4hkfIThC1nXeO6z03tU74w4aqB6T1RR0SFZzGJUx2bBzdzIeih2WfxunKPkvSAlzaw</recordid><startdate>20001001</startdate><enddate>20001001</enddate><creator>Fernandes, H M</creator><creator>Gregson, B</creator><creator>Siddique, S</creator><creator>Mendelow, A D</creator><general>American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20001001</creationdate><title>Surgery in intracerebral hemorrhage. The uncertainty continues</title><author>Fernandes, H M ; Gregson, B ; Siddique, S ; Mendelow, A D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c361t-e9caa1e4a1a9c86a258af4c88377839757df84b223dbe48a035a8e75fde768323</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Cerebral Hemorrhage - diagnostic imaging</topic><topic>Cerebral Hemorrhage - surgery</topic><topic>Humans</topic><topic>Neurosurgical Procedures - adverse effects</topic><topic>Neurosurgical Procedures - mortality</topic><topic>Neurosurgical Procedures - statistics & numerical data</topic><topic>Odds Ratio</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - mortality</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Risk Assessment</topic><topic>Survival Rate</topic><topic>Tomography, X-Ray Computed</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fernandes, H M</creatorcontrib><creatorcontrib>Gregson, B</creatorcontrib><creatorcontrib>Siddique, S</creatorcontrib><creatorcontrib>Mendelow, A D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fernandes, H M</au><au>Gregson, B</au><au>Siddique, S</au><au>Mendelow, A D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Surgery in intracerebral hemorrhage. The uncertainty continues</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2000-10-01</date><risdate>2000</risdate><volume>31</volume><issue>10</issue><spage>2511</spage><epage>2516</epage><pages>2511-2516</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><coden>SJCCA7</coden><abstract>Primary intracerebral hemorrhage (ICH) accounts for 10% to 20% of stroke but carries the highest rates of mortality and morbidity of all stroke subtypes. Current treatment, however, is varied and haphazard. The most recent Cochrane systematic review refers to 4 prospective, randomized controlled trials. We present a further meta-analysis to include 3 new trials. In addition, we review the trials of Chen et al and McKissock et al and discuss aspects of their quality that, we believe, prevent their inclusion in modern day meta-analysis.
Literature databases and articles were searched from 1966 to October 1999. Using the end points of death and dependency, the results of the 7 identified randomized trials were expressed as odds ratios. All available data were then analyzed with meta-analysis techniques. Analysis of relevant subsets of trials was also carried out.
Meta-analysis of all 7 trials shows a trend toward a higher chance of death and dependency after surgery (OR 1.20; 95% CI 0.83 to 1.74). Meta-analysis was also carried out after exclusion of the Chen and McKissock trials for reasons discussed in the text. This meta-analysis suggests a benefit from surgery, with a reduction in the chances of death and dependency after surgical treatment by a factor of 0.63 (OR 0.63; 95% CI 0.35 to 1.14).
When meta-analysis is restricted to modern-day, post-CT, well-constructed, balanced trials, a trend for surgery to reduce the chances of death and dependency is found. Perhaps, then, in the modern era of CT, good neuroanesthesia, intensive care, and the operating microscope, surgery has a role in the treatment of supratentorial intracerebral hemorrhage. The results of a large, multicenter, randomized controlled trial are urgently needed, and the ongoing International Surgical Trial of Intracerebral Hemorrhage should fulfill this objective.</abstract><cop>United States</cop><pub>American Heart Association, Inc</pub><pmid>11022087</pmid><doi>10.1161/01.STR.31.10.2511</doi><tpages>6</tpages></addata></record> |
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subjects | Cerebral Hemorrhage - diagnostic imaging Cerebral Hemorrhage - surgery Humans Neurosurgical Procedures - adverse effects Neurosurgical Procedures - mortality Neurosurgical Procedures - statistics & numerical data Odds Ratio Postoperative Complications - etiology Postoperative Complications - mortality Randomized Controlled Trials as Topic Risk Assessment Survival Rate Tomography, X-Ray Computed Treatment Outcome |
title | Surgery in intracerebral hemorrhage. The uncertainty continues |
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