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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): A randomised trial
The Lancet, Volume 382, No. 9890, Year 2013
Notification
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Description
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. © 2013 Mendelow et al. Open Access article distributed under the terms of CC BY-NC-ND.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3906609/bin/mmc1.pdf
Authors & Co-Authors
Mendelow, Alexander David
United Kingdom, Newcastle
Newcastle University
Gregson, Barbara A.
United Kingdom, Newcastle
Newcastle University
Rowan, Elise N.
United Kingdom, Newcastle
Newcastle University
Murray, Gordon D.
United Kingdom, Edinburgh
Edinburgh Medical School
Gholkar, Anil
United Kingdom, Newcastle
Royal Victoria Infirmary
Mitchell, Patrick M.
United Kingdom, Newcastle
Newcastle University
Gregson, B. A.
Unknown Affiliation
Rowan, E. N.
Unknown Affiliation
Murray, G. D.
Unknown Affiliation
Gholkar, A.
Unknown Affiliation
Mitchell, Peter J.
Unknown Affiliation
Sandercock, Peter A.G.
Unknown Affiliation
Ford, Gary A.
Unknown Affiliation
Barer, David H.
Unknown Affiliation
Strong, Anthony John
Unknown Affiliation
Mitchell, P. M.
Unknown Affiliation
Gholkar, A. R.
Unknown Affiliation
Murray, G. D.
Unknown Affiliation
Mendelow, A. D.
Unknown Affiliation
Gregson, B. A.
Unknown Affiliation
Hanley, Daniel F.
Unknown Affiliation
Hope, David T.
Unknown Affiliation
Skene, Allan M.
Unknown Affiliation
Fernandes, H. M.
Unknown Affiliation
Metcalfe, S.
Unknown Affiliation
Qureshi, Adnan Iqbal
Unknown Affiliation
Prasad, Manjunath K.
Unknown Affiliation
Mendelow, A. D.
Unknown Affiliation
Kenyon, G. M.
Unknown Affiliation
Chilton, L.
Unknown Affiliation
Liao, Z.
Unknown Affiliation
Andras, Alina
Unknown Affiliation
Francis, R.
Unknown Affiliation
Bailey, L.
Unknown Affiliation
Fanarjyan, Ruben
Unknown Affiliation
Kaye, Andrew
Unknown Affiliation
Shehab-Eldien, Abd Elhafiz Elsalam
Egypt, Mansoura
Mansoura International Hospital
King, Andrew T.
Unknown Affiliation
Wassmann, Hansdetlef
Unknown Affiliation
Stranjalis, George
Unknown Affiliation
Sharma, Bhawani Shanker
Unknown Affiliation
Levi, Leon
Unknown Affiliation
Valeinis, Egils
Unknown Affiliation
Krivoshapkin, Alex
Unknown Affiliation
Eljamel, Sam
Unknown Affiliation
Vazquez-Barquero, Alfonso
Unknown Affiliation
Barlas, Orhan
Unknown Affiliation
Loftus, Christopher
Unknown Affiliation
Minasyan, Ararat
Unknown Affiliation
Davis, Stephen M.
Australia, Melbourne
Royal Melbourne Hospital
Kitchener, Nabil
Unknown Affiliation
Tyrrell, Philippa
Unknown Affiliation
Steiner, Thorsten
Unknown Affiliation
Vemmos, Kostas
Unknown Affiliation
Prasad, Kameshwar Nagendra
Unknown Affiliation
Har Nof, Sagi
Unknown Affiliation
Millers, Andrejs
Unknown Affiliation
Makhovskaya, Tatyana
Unknown Affiliation
Al-Shahi Salman, Rustam
United Kingdom, Edinburgh
Western General Hospital
Martín-Láez, Rubén
Unknown Affiliation
Bahar, Sara
Unknown Affiliation
Eidelman, Benjamin
Unknown Affiliation
Freeman, Anne
Unknown Affiliation
Hand, P.
Australia, Melbourne
Royal Melbourne Hospital
Kleinpeter, G.
Austria, Vienna
Rudolfstiftung
Findlay, M.
Canada, Edmonton
University of Alberta Hospital
Zhao, Y.
China, Beijing
Beijing Tiantan Hospital, Capital Medical University
Sin, Y.
China, Shanghai
Huashan Hospital
Hu, J.
China, Shanghai
Huashan Hospital
Krejci, T.
Czech Republic, Ostrava
Faculty Hospital Ostrava
Poticny, S.
Czech Republic, Ostrava
Faculty Hospital Ostrava
Benes, V.
Czech Republic, Prague
Charles University
Bradáč, Ondřej
Czech Republic, Prague
Charles University
Mohapl, M.
Czech Republic, Prague
Charles University
Smrcka, M.
Czech Republic, Brno
Fakultni Nemocnice Brno
Juran, V.
Czech Republic, Brno
Fakultni Nemocnice Brno
Svoboda, K.
Czech Republic, Brno
Fakultni Nemocnice Brno
Buchvald, P.
Czech Republic, Brno
Fakultni Nemocnice Brno
Benes, V.
Czech Republic, Brno
Fakultni Nemocnice Brno
Abdelaziz, Osama S.
Egypt, Alexandria
Alexandria University Hospitals
Zidan, Ihab
Egypt, Alexandria
Alexandria University Hospitals
Kandil, E. M.
Egypt, Mansoura
Mansoura International Hospital
Taher, H. M.
Egypt, Mansoura
Mansoura International Hospital
El-Faresy, M. F.
Egypt, Mansoura
Mansoura International Hospital
Sepehrnia, A.
Germany, Munster
Clemenshospital Münster
Kiwit, J.
Germany, Berlin
Helios Klinikum Berlin-buch
Schreiber, S.
Germany, Berlin
Helios Klinikum Berlin-buch
Youssef, F.
Germany, Berlin
Helios Klinikum Berlin-buch
Buchfelder, Michael
Germany, Erlangen
Universitätsklinikum Erlangen
Swozil, F.
Germany, Erlangen
Universitätsklinikum Erlangen
Kleindienst, A.
Germany, Amberg
Klinikum Amberg
Marin, M.
Germany, Amberg
Klinikum Amberg
Megele, M.
Germany, Amberg
Klinikum Amberg
Hanggi, Daniel
Germany, Dusseldorf
Heinrich-heine-universität Düsseldorf Medizinische Fakultät
Beseoglus, K.
Germany, Dusseldorf
Heinrich-heine-universität Düsseldorf Medizinische Fakultät
Statistics
Citations: 95
Authors: 95
Affiliations: 19
Identifiers
Doi:
10.1016/S0140-6736(13)60986-1
ISSN:
01406736
e-ISSN:
1474547X
Research Areas
Disability
Health System And Policy
Study Design
Randomised Control Trial
Case-Control Study