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Early surgery versus conservative treatment in patients with traumatic intracerebral hematoma: a CENTER-TBI study.
van Erp, Inge A M; van Essen, Thomas A; Lingsma, Hester; Pisica, Dana; Singh, Ranjit D; van Dijck, Jeroen T J M; Volovici, Victor; Kolias, Angelos; Peppel, Lianne D; Heijenbrok-Kal, Majanka; Ribbers, Gerard M; Menon, David K; Hutchinson, Peter; Depreitere, Bart; Steyerberg, Ewout W; Maas, Andrew I R; de Ruiter, Godard C W; Peul, Wilco C.
Afiliación
  • van Erp IAM; University Neurosurgical Centre Holland, LUMC, HMC, HAGA, Leiden and The Hague, The Netherlands. i.a.m.van_erp@lumc.nl.
  • van Essen TA; University Neurosurgical Centre Holland, LUMC, HMC, HAGA, Leiden and The Hague, The Netherlands.
  • Lingsma H; Centre for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands.
  • Pisica D; Centre for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands.
  • Singh RD; Department of Neurosurgery, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands.
  • van Dijck JTJM; University Neurosurgical Centre Holland, LUMC, HMC, HAGA, Leiden and The Hague, The Netherlands.
  • Volovici V; University Neurosurgical Centre Holland, LUMC, HMC, HAGA, Leiden and The Hague, The Netherlands.
  • Kolias A; Centre for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands.
  • Peppel LD; Department of Neurosurgery, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands.
  • Heijenbrok-Kal M; Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK.
  • Ribbers GM; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK.
  • Menon DK; Rijndam Rehabilitation and Department of Rehabilitation Medicine, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands.
  • Hutchinson P; Rijndam Rehabilitation and Department of Rehabilitation Medicine, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands.
  • Depreitere B; Rijndam Rehabilitation and Department of Rehabilitation Medicine, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands.
  • Steyerberg EW; Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
  • Maas AIR; Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK.
  • de Ruiter GCW; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK.
  • Peul WC; Department of Neurosurgery, University Hospital KU Leuven, Leuven, Belgium.
Acta Neurochir (Wien) ; 165(11): 3217-3227, 2023 11.
Article en En | MEDLINE | ID: mdl-37747570
PURPOSE: Evidence regarding the effect of surgery in traumatic intracerebral hematoma (t-ICH) is limited and relies on the STITCH(Trauma) trial. This study is aimed at comparing the effectiveness of early surgery to conservative treatment in patients with a t-ICH. METHODS: In a prospective cohort, we included patients with a large t-ICH (< 48 h of injury). Primary outcome was the Glasgow Outcome Scale Extended (GOSE) at 6 months, analyzed with multivariable proportional odds logistic regression. Subgroups included injury severity and isolated vs. non-isolated t-ICH. RESULTS: A total of 367 patients with a large t-ICH were included, of whom 160 received early surgery and 207 received conservative treatment. Patients receiving early surgery were younger (median age 54 vs. 58 years) and more severely injured (median Glasgow Coma Scale 7 vs. 10) compared to those treated conservatively. In the overall cohort, early surgery was not associated with better functional outcome (adjusted odds ratio (AOR) 1.1, (95% CI, 0.6-1.7)) compared to conservative treatment. Early surgery was associated with better outcome for patients with moderate TBI and isolated t-ICH (AOR 1.5 (95% CI, 1.1-2.0); P value for interaction 0.71, and AOR 1.8 (95% CI, 1.3-2.5); P value for interaction 0.004). Conversely, in mild TBI and those with a smaller t-ICH (< 33 cc), conservative treatment was associated with better outcome (AOR 0.6 (95% CI, 0.4-0.9); P value for interaction 0.71, and AOR 0.8 (95% CI, 0.5-1.0); P value for interaction 0.32). CONCLUSIONS: Early surgery in t-ICH might benefit those with moderate TBI and isolated t-ICH, comparable with results of the STITCH(Trauma) trial.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Hemorragia Intracraneal Traumática / Tratamiento Conservador Límite: Humans / Middle aged Idioma: En Revista: Acta Neurochir (Wien) Año: 2023 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Austria
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Hemorragia Intracraneal Traumática / Tratamiento Conservador Límite: Humans / Middle aged Idioma: En Revista: Acta Neurochir (Wien) Año: 2023 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Austria