Early surgery versus conservative treatment in patients with traumatic intracerebral hematoma: a CENTER-TBI study

Le résumé fourni par la source

Background: Traumatic intracerebral hematoma (t-ICH) is common and associated with unfavourable outcome.Nevertheless, evidence regarding the optimal treatment is limited and relies mostly on the STITCH (Trauma) trial.Our study aims to compare the effectiveness of early surgery (ES) to initial conservative treatment (ICT) in patients with a t-ICH.Methods: Two prospective observational studies that included patients from 2015 to 2020 were analyzed.Patients with TBI and a large t-ICH within 48 hours of the injury were included.ES was defined as craniotomy with hematoma evacuation and/or decompressive craniectomy.ICT consisted of monitoring and medical management and could contain delayed surgery (>48 hours).Primary outcome was the Glasgow Outcome Scale Extended (GOSE) score at 6 months analysed with multivariable proportional odds logistic regression.Secondary outcomes were in-hospital mortality, treatment failure, dichotomized GOSE and Quality of Life after Brain Injury at 6 months.Subgroups included injury severity (mild vs. moderate vs. severe) and isolated vs. non-isolated t-ICH.Results:Overall, 367 patients with a large t-ICH were included, of whom 160 received ES and 207 received ICT.Patients in the ES group were younger (median age 54 vs. 58 years), and more severely injured (median GCS 7 vs. 10) compared to those in the ICT group.After adjustment for confounders, ES nor ICT was significantly associated with better functional outcome (odds ratio (OR) 1.1, 95% CI [0.6-1.7]).Similar results were found for the secondary outcomes.In moderate TBI and isolated t-ICH, ES was associated with better outcome (OR 1.5 [95% CI, 1.1-2.0],and 1.8 [95% CI, 1.3-2.5],respectively).Conversely, in mild TBI and those with a smaller t-ICH (<33cc) ICT was associated with better outcome (OR 0.6 [95% CI, 0.4-0.9]and 0.8 [95% CI, 0.5-1.0],respectively).Conclusion: Early surgery in t-ICH may only benefit those with moderate TBI and isolated t-ICH, compatible with observed effects in the STITCH (Trauma) trial.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.