Individual patient data subgroup meta-analysis of surgery for spontaneous supratentorial intracerebral hemorrhage.
Individual patient data subgroup meta-analysis of surgery for spontaneous supratentorial intracerebral hemorrhage.
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DOI：
10.1161/strokeaha.111.640284
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发表时间：
2012-06
期刊：
影响因子：
8.3
通讯作者：
Mendelow AD
中科院分区：
文献类型：
--
作者：
Gregson BA;Broderick JP;Auer LM;Batjer H;Chen XC;Juvela S;Morgenstern LB;Pantazis GC;Teernstra OP;Wang WZ;Zuccarello M;Mendelow AD
截至2010年，已有14项已发表的脑出血手术试验在系统综述中或向作者报告，但手术干预的作用和时机仍存在争议，实践仍然是随意的。本研究试图从1985年以来发表的13项研究中获得个体患者数据，以便更好地定义可能从手术中受益的患者组。通过邮件、电子邮件和会议与已发表论文的作者联系，并邀请他们参加研究。数据来自8项研究（2186例病例）。个体患者数据包括患者的年龄、就诊时的GCS、血肿的体积和部位、IVH的存在、排空方法、随机化时间和结局。荟萃分析表明，如果在发作后8小时内进行手术（p = 0.003），或血肿体积为20- 50 ml，则手术结局改善。（p = 0.004），或GCS在9和12之间（p = 0.0009），或患者年龄在50和69之间（p = 0.01）。此外，有一些证据表明，没有IVH的更多浅表血肿也可能受益（p = 0.09）。有证据表明，如果在病人病情恶化之前及早进行手术，是有益的。这项工作确定了进一步研究的领域。正在进行的患者亚组研究，如斯蒂奇II，将证实这些解释是否可以重复。
By 2010 there had been 14 published trials of surgery for intracerebral haemorrhage reported in systematic reviews or to the authors, but the role and timing of operative intervention remains controversial and the practice continues to be haphazard. This study attempted to obtain individual patient data from each of the 13 studies published since 1985 in order to better define groups of patients that might benefit from surgery. Authors of identified published papers were approached by mail, email and at conferences and invited to take part in the study. Data were obtained from 8 studies (2186 cases). Individual patient data included patient's age, GCS at presentation, volume and site of haematoma, presence of IVH, method of evacuation, time to randomisation and outcome. Meta-analysis indicated that there was improved outcome with surgery if it was undertaken within 8 hours of ictus (p = 0.003), or the volume of the haematoma was 20-50ml. (p = 0.004), or the GCS was between 9 and 12 (p = 0.0009), or the patient was aged between 50 and 69 (p = 0.01). In addition there was some evidence that more superficial haematomas with no IVH might also benefit (p = 0.09). There is evidence that surgery is of benefit if undertaken early before the patient deteriorates. This work identifies areas for further research. Ongoing studies in subgroups of patients, such as STICH II, will confirm whether these interpretations can be replicated.