Early surgery versus initial conservative treatment in patients
with spontaneous supratentorial lobar intracerebral haematomas
(STICH II): a randomised trial

J 2013

Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial

MENDELOW, David A, Barbara A GREGSON, Elise N ROWAN, Gordon D MURRAY, Anil GHOLKAR et. al.

Základní údaje

Originální název

Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial

Autoři

MENDELOW, David A, Barbara A GREGSON, Elise N ROWAN, Gordon D MURRAY, Anil GHOLKAR a Patrick M MITCHELL

Vydání

Lancet, NEW YORK, ELSEVIER SCIENCE INC, 2013, 0140-6736

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30000 3. Medical and Health Sciences

Stát vydavatele

Spojené státy

Utajení

není předmětem státního či obchodního tajemství

Impakt faktor

Impact factor: 39.207

Organizační jednotka

Lékařská fakulta

DOI

http://dx.doi.org/10.1016/S0140-6736(13)60986-1

UT WoS

000322638500032

Změněno: 10. 1. 2014 16:21, Ing. Mgr. Věra Pospíšilíková

Anotace

V originále

Background: The balance of risk and benefit from early neurosurgical intervention for conscious patients with superficial lobar intracerebral haemorrhage of 10-100 mL and no intraventricular haemorrhage admitted within 48 h of ictus is unclear. We therefore tested the hypothesis that early surgery compared with initial conservative treatment could improve outcome in these patients. Methods: In this international, parallel-group trial undertaken in 78 centres in 27 countries, we compared early surgical haematoma evacuation within 12 h of randomisation plus medical treatment with initial medical treatment alone (later evacuation was allowed if judged necessary). An automatic telephone and internet-based randomisation service was used to assign patients to surgery and initial conservative treatment in a 1: 1 ratio. The trial was not masked. The primary outcome was a prognosis-based dichotomised (favourable or unfavourable) outcome of the 8 point Extended Glasgow Outcome Scale (GOSE) obtained by questionnaires posted to patients at 6 months. Analysis was by intention to treat. This trial is registered, number ISRCTN22153967. Findings: 307 of 601 patients were randomly assigned to early surgery and 294 to initial conservative treatment; 298 and 291 were followed up at 6 months, respectively; and 297 and 286 were included in the analysis, respectively. 174 (59%) of 297 patients in the early surgery group had an unfavourable outcome versus 178 (62%) of 286 patients in the initial conservative treatment group (absolute difference 3.7% [95% CI -4.3 to 11.6], odds ratio 0.86 [0.62 to 1.20]; p=0.367). Interpretation: The STICH II results confirm that early surgery does not increase the rate of death or disability at 6 months and might have a small but clinically relevant survival advantage for patients with spontaneous superficial intracerebral haemorrhage without intraventricular haemorrhage.

Citovat

MENDELOW, David A, Barbara A GREGSON, Elise N ROWAN, Gordon D MURRAY, Anil GHOLKAR a Patrick M MITCHELL. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet. NEW YORK: ELSEVIER SCIENCE INC, 2013, roč. 382, č. 9890, s. 397-408. ISSN 0140-6736. Dostupné z: https://dx.doi.org/10.1016/S0140-6736(13)60986-1.

@article{1139386,
   author = {Mendelow, David A and Gregson, Barbara A and Rowan, Elise N and Murray, Gordon D and Gholkar, Anil and Mitchell, Patrick M and Smrčka, Martin},
   article_location = {NEW YORK},
   article_number = {9890},
   doi = {http://dx.doi.org/10.1016/S0140-6736(13)60986-1},
   language = {eng},
   issn = {0140-6736},
   journal = {Lancet},
   note = {Nepřevádět do RIV - prof. Smrčka uveden v the STICH II Investigators},
   title = {Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial},
   volume = {382},
   year = {2013}
}

TY  - JOUR
ID  - 1139386
AU  - Mendelow, David A - Gregson, Barbara A - Rowan, Elise N - Murray, Gordon D - Gholkar, Anil - Mitchell, Patrick M - Smrčka, Martin
PY  - 2013
TI  - Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial
JF  - Lancet
VL  - 382
IS  - 9890
SP  - 397-408
EP  - 397-408
PB  - ELSEVIER SCIENCE INC
SN  - 01406736
N1  - Nepřevádět do RIV - prof. Smrčka uveden v the STICH II Investigators
N2  - Background: The balance of risk and benefit from early neurosurgical intervention for conscious patients with superficial lobar intracerebral haemorrhage of 10-100 mL and no intraventricular haemorrhage admitted within 48 h of ictus is unclear. We therefore tested the hypothesis that early surgery compared with initial conservative treatment could improve outcome in these patients. Methods: In this international, parallel-group trial undertaken in 78 centres in 27 countries, we compared early surgical haematoma evacuation within 12 h of randomisation plus medical treatment with initial medical treatment alone (later evacuation was allowed if judged necessary). An automatic telephone and internet-based randomisation service was used to assign patients to surgery and initial conservative treatment in a 1: 1 ratio. The trial was not masked. The primary outcome was a prognosis-based dichotomised (favourable or unfavourable) outcome of the 8 point Extended Glasgow Outcome Scale (GOSE) obtained by questionnaires posted to patients at 6 months. Analysis was by intention to treat. This trial is registered, number ISRCTN22153967. Findings: 307 of 601 patients were randomly assigned to early surgery and 294 to initial conservative treatment; 298 and 291 were followed up at 6 months, respectively; and 297 and 286 were included in the analysis, respectively. 174 (59%) of 297 patients in the early surgery group had an unfavourable outcome versus 178 (62%) of 286 patients in the initial conservative treatment group (absolute difference 3.7% [95% CI -4.3 to 11.6], odds ratio 0.86 [0.62 to 1.20]; p=0.367). Interpretation: The STICH II results confirm that early surgery does not increase the rate of death or disability at 6 months and might have a small but clinically relevant survival advantage for patients with spontaneous superficial intracerebral haemorrhage without intraventricular haemorrhage.
ER  -

MENDELOW, David A, Barbara A GREGSON, Elise N ROWAN, Gordon D MURRAY, Anil GHOLKAR a Patrick M MITCHELL. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. \textit{Lancet}. NEW YORK: ELSEVIER SCIENCE INC, 2013, roč.~382, č.~9890, s.~397-408. ISSN~0140-6736. Dostupné z: https://dx.doi.org/10.1016/S0140-6736(13)60986-1.

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