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001-es BibID:	BIBFORM045987
Első szerző:	Gregson, Barbara A.
Cím:	International Variations in Surgical Practice for Spontaneous Intracerebral Hemorrhage / Barbara A. Gregson, A. David Mendelow, STICH Investigators
Dátum:	2003
ISSN:	0039-2499 1524-4628
Megjegyzések:	Background and Purpose -Spontaneous intracerebral hemorrhage is a major cause of death and disability, yet there is no convincing evidence of the benefit of any medical treatment and the role of surgery remains controversial. The international randomized Surgical Trial in Intracerebral Hemorrhage (STICH) provided an opportunity to assess the role of surgery within the centers taking part. Methods -Screening logs were completed to record details of all patients assessed by the department, whether they were included in the trial, the reasons if they were not included, and whether they underwent surgery. Results -Logs were returned by 42 centers and cover 704 months. They include details on 1578 patients with characteristics comparable to STICH inclusion criteria. Neurosurgeons were more likely to express clinical certainty about treatment for older patients, patients with a higher Glasgow Coma Score scale, and patients in whom the hematoma was located on the right or in the basal ganglia or thalamus. Patients for whom the neurosurgeon was certain about treatment were more likely to have the hematoma removed if they were younger (62 versus 68 years of age), had a lower Glasgow Coma Scale score (10 versus 13), and had a lobar hematoma (49% versus 40%). The operation rate varied between 74% in Lithuania and 2% in Hungary. Conclusions -The difference in operation rates could not be explained by differences in patient characteristics alone. This finding demonstrates the need for further evidence to ensure that treatment for intracerebral hemorrhage is not governed by local custom. ( Stroke . 2003;34:2593-2598.)
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban intracranial hemorrhages multicenter studies physician's practice patterns surgery
Megjelenés:	Stroke. - 34 : 11 (2003), p. 2593-2598. -
További szerzők:	Mendelow, A. David Szabó Sándor (1957-) (idegsebész) Bereczki Dániel (1960-) (neurológus) STICH Investigators
Internet cím:	Intézményi repozitóriumban (DEA) tárolt változat DOI Szerző által megadott URL
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001-es BibID:	BIBFORM038659
035-os BibID:	WOS:000226610900025 PMID:15680453
Első szerző:	Mendelow, A. David
Cím:	Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH) : a randomised trial / A. David Mendelow, Barbara A. Gregson, Helen M. Fernandes, Gordon D. Murray, Graham M. Teasdale, D. Terence Hope, Abbas Karimi, M. Donald M. Shaw, David H. Barer, The STICH Investigators
Dátum:	2005
ISSN:	0140-6736
Megjegyzések:	Spontaneous supratentorial intracerebral haemorrhage accounts for 20% of all stroke-related sudden neurological deficits, has the highest morbidity and mortality of all stroke, and the role of surgery remains controversial. We undertook a prospective randomised trial to compare early surgery with initial conservative treatment for patients with intracerebral haemorrhage. METHODS: A parallel-group trial design was used. Early surgery combined haematoma evacuation (within 24 h of randomisation) with medical treatment. Initial conservative treatment used medical treatment, although later evacuation was allowed if necessary. We used the eight-point Glasgow outcome scale obtained by postal questionnaires sent directly to patients at 6 months follow-up as the primary outcome measure. We divided the patients into good and poor prognosis groups on the basis of their clinical status at randomisation. For the good prognosis group, a favourable outcome was defined as good recovery or moderate disability on the Glasgow outcome scale. For the poor prognosis group, a favourable outcome also included the upper level of severe disability. Analysis was by intention to treat. FINDINGS: 1033 patients from 83 centres in 27 countries were randomised to early surgery (503) or initial conservative treatment (530). At 6 months, 51 patients were lost to follow-up, and 17 were alive with unknown status. Of 468 patients randomised to early surgery, 122 (26%) had a favourable outcome compared with 118 (24%) of 496 randomised to initial conservative treatment (odds ratio 0.89 [95% CI 0.66-1.19], p=0.414); absolute benefit 2.3% (-3.2 to 7.7), relative benefit 10% (-13 to 33). INTERPRETATION: Patients with spontaneous supratentorial intracerebral haemorrhage in neurosurgical units show no overall benefit from early surgery when compared with initial conservative treatment.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Megjelenés:	Lancet. - 365 : 9457 (2005), p. 387-397. -
További szerzők:	Gregson, Barbara A. Fernandes, Helen M. Murray, Gordon D. Teasdale, Graham M. Hope, D. Terence Karimi, Abbas Shaw, M. Donald M. Bare, David H. Szabó Sándor (1957-) (idegsebész) STICH Investigators
Internet cím:	Szerző által megadott URL Intézményi repozitóriumban (DEA) tárolt változat DOI
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