Association of Surgical Hematoma Evacuation vs Conservative Treatment With Functional Outcome in Patients With Cerebellar Intracerebral Hemorrhage

被引：99

作者：

Kuramatsu, Joji B. ^{[1
]}

Biffi, Alessandro ^{[2
,3
]}

Gerner, Stefan T. ^{[1
]}

Sembill, Jochen A. ^{[1
]}

Spruegel, Maximilian I. ^{[1
]}

Leasure, Audrey ^{[4
]}

Sansing, Lauren ^{[4
]}

Matouk, Charles ^{[4
]}

Falcone, Guido J. ^{[4
]}

Endres, Matthias ^{[5
,6
,7
,8
]}

Haeusler, Karl Georg ^{[5
,6
,9
]}

Sobesky, Jan ^{[5
,6
]}

Schurig, Johannes ^{[6
]}

Zweynert, Sarah ^{[5
]}

Bauer, Miriam ^{[6
]}

Vajkoczy, Peter ^{[10
]}

Ringleb, Peter A. ^{[11
]}

Purrucker, Jan ^{[11
]}

Rizos, Timolaos ^{[11
,12
]}

Volkmann, Jens ^{[9
]}

Muellges, Wolfgang ^{[9
]}

Kraft, Peter ^{[9
]}

Schubert, Anna-Lena ^{[9
]}

Erbguth, Frank ^{[13
]}

Nueckel, Martin ^{[13
]}

Schellinger, Peter D. ^{[14
]}

Glahn, Joerg ^{[14
]}

Knappe, Ulrich J. ^{[15
]}

Fink, Gereon R. ^{[16
]}

Dohmen, Christian ^{[16
]}

Stetefeld, Henning ^{[16
]}

Fisse, Anna Lena ^{[17
]}

Minnerup, Jens ^{[17
]}

Hagemann, Georg ^{[18
]}

Rakers, Florian ^{[18
]}

Reichmann, Heinz ^{[19
]}

Schneider, Hauke ^{[19
,20
]}

Rahmig, Jan ^{[19
]}

Ludolph, Albert Christian ^{[21
]}

Stoesser, Sebastian ^{[21
]}

Neugebauer, Hermann ^{[9
,21
]}

Roether, Joachim ^{[22
]}

Michels, Peter ^{[22
]}

Schwarz, Michael ^{[23
]}

Reimann, Gernot ^{[23
]}

Baezner, Hansjoerg ^{[24
]}

Schwert, Henning ^{[24
]}

Classen, Joseph ^{[25
]}

Michalski, Dominik ^{[25
]}

Grau, Armin ^{[26
]}

机构：

[1] Univ Erlangen Nurnberg, Dept Neurol, Schwabachanlage 6, D-91054 Erlangen, Germany

[2] Massachusetts Gen Hosp, Dept Neurol, Boston, MA 02114 USA

[3] J Philip Kistler Stroke Res Ctr, Hemorrhag Stroke Res Program, Boston, MA USA

[4] Yale Univ, Sch Med, Dept Neurol, New Haven, CT 06510 USA

[5] Charite Univ Med Berlin, Dept Neurol, Berlin, Germany

[6] Charite Univ Med Berlin, Ctr Stroke Res Berlin, Berlin, Germany

[7] German Ctr Cardiovasc Res DZHK, Berlin, Germany

[8] German Ctr Neurodegenerat Dis DZNE, Partner Site Berlin, Berlin, Germany

[9] Univ Wurzburg, Dept Neurol, Wurzburg, Germany

[10] Charite Univ Med Berlin, Dept Neurosurg, Berlin, Germany

[11] Heidelberg Univ Hosp, Dept Neurol, Heidelberg, Germany

[12] Alfried Krupp Krankenhaus Essen, Dept Neurol, Essen, Germany

[13] Community Hosp Nuremberg, Dept Neurol, Nurnberg, Germany

[14] UK RUB, Johannes Wesling Med Ctr, Dept Neurol & Neurogeriatry, Minden, Germany

[15] UK RUB, Johannes Wesling Med Ctr Minden, Dept Neurosurg, Minden, Germany

[16] Univ Cologne, Dept Neurol, Cologne, Germany

[17] Univ Munster, Dept Neurol, Munster, Germany

[18] Community Hosp Helios Klinikum Berlin Buch, Dept Neurol, Berlin, Germany

[19] Univ Dresden, Dept Neurol, Dresden, Germany

[20] Klinikum Augsburg, Dept Neurol, Augsburg, Germany

[21] Univ Ulm, Dept Neurol, Ulm, Germany

[22] Community Hosp Asklepios Klin Hamburg Altona, Dept Neurol, Hamburg, Germany

[23] Community Hosp Klinikum Dortmund, Dept Neurol, Dortmund, Germany

[24] Community Hosp Klinikum Stuttgart, Dept Neurol, Stuttgart, Germany

[25] Univ Leipzig, Dept Neurol, Leipzig, Germany

[26] Community Hosp Klinikum Stadt Ludwigshafen Rhein, Dept Neurol, Ludwigshafen, Germany

[27] Community Hosp Klinikum Koblenz, Dept Neurol, Koblenz, Germany

[28] Community Hosp Bad Hersfeld, Dept Neurol, Bad Hersfeld, Germany

[29] Univ Jena, Dept Neurol, Jena, Germany

[30] Bezirkskrankenhaus Gunzburg, Dept Neurol & Neurol Rehabil, Gunzburg, Germany

[31] Univ Erlangen Nurnberg, Dept Neuroradiol, Erlangen, Germany

[32] Univ Illinois, Coll Med, Dept Neurol & Rehabil, Chicago, IL USA

[33] Univ Cincinnati, Dept Neurol & Rehabil Med, Cincinnati, OH USA

来源：

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2019年 / 322卷 / 14期

关键词：

INDIVIDUAL PARTICIPANT DATA; MIDDLE CEREBRAL-ARTERY; VITAMIN-K ANTAGONIST; STROKE; METAANALYSIS; DECOMPRESSION; MULTICENTER; GUIDELINES; MANAGEMENT; INFARCTION;

D O I：

10.1001/jama.2019.13014

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

IMPORTANCE The association of surgical hematoma evacuation with clinical outcomes in patients with cerebellar intracerebral hemorrhage (ICH) has not been established. OBJECTIVE To determine the association of surgical hematoma evacuation with clinical outcomes in cerebellar ICH. DESIGN, SETTING, AND PARTICIPANTS Individual participant data (IPD) meta-analysis of 4 observational ICH studies incorporating 6580 patients treated at 64 hospitals across the United States and Germany (2006-2015). EXPOSURE Surgical hematoma evacuation vs conservative treatment. MAIN OUTCOMES AND MEASURES The primary outcome was functional disability evaluated by the modified Rankin Scale ([mRS] score range: 0, no functional deficit to 6, death) at 3 months; favorable (mRS, 0-3) vs unfavorable (mRS, 4-6). Secondary outcomes included survival at 3 months and at 12 months. Analyses included propensity score matching and covariate adjustment, and predicted probabilities were used to identify treatment-related cutoff values for cerebellar ICH. RESULTS Among 578 patients with cerebellar ICH, propensity score-matched groups included 152 patients with surgical hematoma evacuation vs 152 patients with conservative treatment (age, 68.9 vs 69.2 years; men, 55.9% vs 51.3%; prior anticoagulation, 60.5% vs 63.8%; and median ICH volume, 20.5 cm(3) vs 18.8 cm(3)). After adjustment, surgical hematoma evacuation vs conservative treatment was not significantly associated with likelihood of better functional disability at 3 months (30.9% vs 35.5%; adjusted odds ratio [AOR], 0.94 [95% CI, 0.81 to 1.09], P = .43; adjusted risk difference [ARD], -3.7% [95% CI, -8.7% to 1.2%]) but was significantly associated with greater probability of survival at 3 months (78.3% vs 61.2%; AOR, 1.25 [95% CI, 1.07 to 1.45], P = .005; ARD, 18.5% [95% CI, 13.8% to 23.2%]) and at 12 months (71.7% vs 57.2%; AOR, 1.21 [95% CI, 1.03 to 1.42], P = .02; ARD, 17.0% [95% CI, 11.5% to 22.6%]). A volume range of 12 to 15 cm(3) was identified; below this level, surgical hematoma evacuation was associated with lower likelihood of favorable functional outcome (volume <= 12 cm(3), 30.6% vs 62.3% [P = .003]; ARD, -34.7% [-38.8% to -30.6%]; P value for interaction, .01), and above, it was associated with greater likelihood of survival (volume >= 15 cm(3), 74.5% vs 45.1% [P < .001]; ARD, 28.2% [95% CI, 24.6% to 31.8%]; P value for interaction, .02). CONCLUSIONS AND RELEVANCE Among patients with cerebellar ICH, surgical hematoma evacuation, compared with conservative treatment, was not associated with improved functional outcome. Given the null primary outcome, investigation is necessary to establish whether there are differing associations based on hematoma volume.

引用

页码：1392 / 1403

页数：12

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