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Surgical management and case-fatality rates of intracerebral hemorrhage in 1988 and 2005.
MedLine Citation:
PMID:  19057323     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To compare surgical management and case-fatality rates of intracerebral hemorrhage (ICH) in 1988 and 2005.
METHODS: We identified all adult residents (age, >or=18 years) from the 5-county Greater Cincinnati region who were hospitalized with ICH in 1988 and 2005. Demographics, severity of illness, ICH volume, ICH location, rates and timing of surgery, and 30-day case-fatality rate were compared between the groups.
RESULTS: In 1988, 171 ICH patients (67 lobar, 80 deep cerebral, 10 brainstem, and 14 cerebellar) met the study criteria; in 2005, 259 ICH patients (91 lobar, 123 deep cerebral, 19 brainstem, and 26 cerebellar) met the study criteria. In 1988, 16% of the patients had surgical removal of their ICH versus 7% in 2005 (P = 0.003). In both 1988 and 2005, patients treated with surgery were younger (P < 0.001) and had a higher percentage of cerebellar hemorrhages than nonsurgical patients. The timing of surgery was similar in 1988 and 2005. In 1988, the 30-day case-fatality rate was 32% in surgical patients versus 50% in nonsurgical patients (P = 0.06). In 2005, the 30-day case-fatality rate was 16% (surgical) versus 45% (nonsurgical) (P = 0.02).
CONCLUSION: The frequency of surgery for ICH was lower in 2005 than in 1988, which may reflect the influence of recent clinical trial data showing no benefit for surgery rather than medical management. The ICH case-fatality rate was essentially the same in 1988 and 2005. Innovative clinical trials to improve ICH outcomes are warranted.
Authors:
Opeolu Adeoye; Daniel Woo; Mary Haverbusch; Padmini Sekar; Charles J Moomaw; Joseph Broderick; Matthew L Flaherty
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  63     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-12-05     Completed Date:  2009-02-19     Revised Date:  2014-09-20    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1113-7; discussion 1117-8     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Cerebral Hemorrhage / mortality*,  surgery*
Female
Humans
Incidence
Male
Neurosurgical Procedures / mortality*
Ohio / epidemiology
Retrospective Studies
Risk Assessment / methods*
Risk Factors
Survival Analysis
Survival Rate
Grant Support
ID/Acronym/Agency:
R01 NS036695/NS/NINDS NIH HHS; R01 NS036695-05A2/NS/NINDS NIH HHS
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