Kuramatsu, Joji B., Biffi, Alessandro, Gerner, Stefan T., Sembill, Jochen A. ORCID: 0000-0003-0014-3389, Spruegel, Maximilian I., Leasure, Audrey, Sansing, Lauren ORCID: 0000-0002-6898-1680, Matouk, Charles, Falcone, Guido J., Endres, Matthias, Haeusler, Karl Georg, Sobesky, Jan, Schurig, Johannes, Zweynert, Sarah, Bauer, Miriam, Vajkoczy, Peter, Ringleb, Peter A., Purrucker, Jan, Rizos, Timolaos, Volkmann, Jens, Muellges, Wolfgang, Kraft, Peter, Schubert, Anna-Lena, Erbguth, Frank, Nueckel, Martin, Schellinger, Peter D., Glahn, Joerg, Knappe, Ulrich J., Fink, Gereon R. ORCID: 0000-0002-8230-1856, Dohmen, Christian, Stetefeld, Henning, Fisse, Anna Lena, Minnerup, Jens, Hagemann, Georg, Rakers, Florian, Reichmann, Heinz, Schneider, Hauke ORCID: 0000-0002-9641-0922, Rahmig, Jan, Ludolph, Albert Christian, Stoesser, Sebastian, Neugebauer, Hermann ORCID: 0000-0003-3759-356X, Roether, Joachim, Michels, Peter, Schwarz, Michael, Reimann, Gernot, Baezner, Hansjoerg, Schwert, Henning, Classen, Joseph ORCID: 0000-0001-7182-6967, Michalski, Dominik, Grau, Armin, Palm, Frederick, Urbanek, Christian, Woehrle, Johannes C., Alshammari, Fahid, Horn, Markus, Bahner, Dirk, Witte, Otto W., Guenther, Albrecht, Hamann, Gerhard F., Hagen, Manuel, Roeder, Sebastian S., Luecking, Hannes, Doerfler, Arnd, Testai, Fernando D., Woo, Daniel, Schwab, Stefan, Sheth, Kevin N. and Huttner, Hagen B. (2019). Association of Surgical Hematoma Evacuation vs Conservative Treatment With Functional Outcome in Patients With Cerebellar Intracerebral Hemorrhage. JAMA-J. Am. Med. Assoc., 322 (14). S. 1392 - 1404. CHICAGO: AMER MEDICAL ASSOC. ISSN 1538-3598

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Abstract

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.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Kuramatsu, Joji B.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Biffi, AlessandroUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gerner, Stefan T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sembill, Jochen A.UNSPECIFIEDorcid.org/0000-0003-0014-3389UNSPECIFIED
Spruegel, Maximilian I.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Leasure, AudreyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sansing, LaurenUNSPECIFIEDorcid.org/0000-0002-6898-1680UNSPECIFIED
Matouk, CharlesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Falcone, Guido J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Endres, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Haeusler, Karl GeorgUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sobesky, JanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schurig, JohannesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zweynert, SarahUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bauer, MiriamUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vajkoczy, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ringleb, Peter A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Purrucker, JanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rizos, TimolaosUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Volkmann, JensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Muellges, WolfgangUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kraft, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schubert, Anna-LenaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Erbguth, FrankUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nueckel, MartinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schellinger, Peter D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Glahn, JoergUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Knappe, Ulrich J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fink, Gereon R.UNSPECIFIEDorcid.org/0000-0002-8230-1856UNSPECIFIED
Dohmen, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stetefeld, HenningUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fisse, Anna LenaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Minnerup, JensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hagemann, GeorgUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rakers, FlorianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reichmann, HeinzUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schneider, HaukeUNSPECIFIEDorcid.org/0000-0002-9641-0922UNSPECIFIED
Rahmig, JanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ludolph, Albert ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stoesser, SebastianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Neugebauer, HermannUNSPECIFIEDorcid.org/0000-0003-3759-356XUNSPECIFIED
Roether, JoachimUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Michels, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schwarz, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reimann, GernotUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Baezner, HansjoergUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schwert, HenningUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Classen, JosephUNSPECIFIEDorcid.org/0000-0001-7182-6967UNSPECIFIED
Michalski, DominikUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Grau, ArminUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Palm, FrederickUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Urbanek, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Woehrle, Johannes C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Alshammari, FahidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Horn, MarkusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bahner, DirkUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Witte, Otto W.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Guenther, AlbrechtUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hamann, Gerhard F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hagen, ManuelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Roeder, Sebastian S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Luecking, HannesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Doerfler, ArndUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Testai, Fernando D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Woo, DanielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schwab, StefanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sheth, Kevin N.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Huttner, Hagen B.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-131231
DOI: 10.1001/jama.2019.13014
Journal or Publication Title: JAMA-J. Am. Med. Assoc.
Volume: 322
Number: 14
Page Range: S. 1392 - 1404
Date: 2019
Publisher: AMER MEDICAL ASSOC
Place of Publication: CHICAGO
ISSN: 1538-3598
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
INDIVIDUAL PARTICIPANT DATA; MIDDLE CEREBRAL-ARTERY; VITAMIN-K ANTAGONIST; STROKE; METAANALYSIS; DECOMPRESSION; MULTICENTER; GUIDELINES; MANAGEMENT; INFARCTIONMultiple languages
Medicine, General & InternalMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/13123

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