Early Surgery versus Initial Conservative Treatment in Patients with Traumatic Intracerebral Hemorrhage (STITCH[Trauma]): The First Randomized Trial

MENDELOW, David A., Barbara A. GREGSON, Elise N. ROWAN, Richard FRANCIS, Elaine MCCOLL, Paul MCNAMEE, Iain CHAMBERS, Andreas UNTERBERG, Dwayne BOYERS a Patrick M. MITCHELL. Early Surgery versus Initial Conservative Treatment in Patients with Traumatic Intracerebral Hemorrhage (STITCH[Trauma]): The First Randomized Trial. Journal of Neurotrauma. New Rochelle: MARY ANN LIEBERT, 2015, roč. 32, č. 17, s. 1312-1323. ISSN 0897-7151. Dostupné z: https://dx.doi.org/10.1089/neu.2014.3644.

Základní údaje

• Originální název: Early Surgery versus Initial Conservative Treatment in Patients with Traumatic Intracerebral Hemorrhage (STITCH[Trauma]): The First Randomized Trial
• Autoři: MENDELOW, David A., Barbara A. GREGSON, Elise N. ROWAN, Richard FRANCIS, Elaine MCCOLL, Paul MCNAMEE, Iain CHAMBERS, Andreas UNTERBERG, Dwayne BOYERS a Patrick M. MITCHELL.
• Vydání: Journal of Neurotrauma, New Rochelle, MARY ANN LIEBERT, 2015, 0897-7151.

Další údaje

• Originální jazyk: angličtina
• Typ výsledku: Článek v odborném periodiku
• Obor: 30200 3.2 Clinical medicine
• Stát vydavatele: Spojené státy
• Utajení: není předmětem státního či obchodního tajemství
• WWW: URL
• Impakt faktor: Impact factor: 4.377
• Organizační jednotka: Lékařská fakulta
• Doi: http://dx.doi.org/10.1089/neu.2014.3644
• UT WoS: 000359564500005
• Klíčová slova anglicky: craniotomy; intracerebral hemorrhage; randomized; controlled trial; traumatic brain injury
• Štítky: EL OK

Anotace

Intraparenchymal hemorrhages occur in a proportion of severe traumatic brain injury TBI patients, but the role of surgery in their treatment is unclear. This international multi-center, patient-randomized, parallel-group trial compared early surgery (hematoma evacuation within 12 h of randomization) with initial conservative treatment (subsequent evacuation allowed if deemed necessary). Patients were randomized using an independent randomization service within 48 h of TBI. Patients were eligible if they had no more than two intraparenchymal hemorrhages of 10mL or more and did not have an extradural or subdural hematoma that required surgery. The primary outcome measure was the traditional dichotomous split of the Glasgow Outcome Scale obtained by postal questionnaires sent directly to patients at 6 months. The trial was halted early by the UK funding agency (NIHR HTA) for failure to recruit sufficient patients from the UK (trial registration: ISRCTN19321911). A total of 170 patients were randomized from 31 of 59 registered centers worldwide. Of 82 patients randomized to early surgery with complete follow-up, 30 (37%) had an unfavorable outcome. Of 85 patients randomized to initial conservative treatment with complete follow-up, 40 (47%) had an unfavorable outcome (odds ratio, 0.65; 95% confidence interval, CI 0.35, 1.21; p = 0.17), with an absolute benefit of 10.5% (CI, - 4.4–25.3%). There were significantly more deaths in the first 6 months in the initial conservative treatment group (33% vs. 15%; p = 0.006). The 10.5% absolute benefit with early surgery was consistent with the initial power calculation. However, with the low sample size resulting from the premature termination, we cannot exclude the possibility that this could be a chance finding. A further trial is required urgently to assess whether this encouraging signal can be confirmed.