Stroke: haematoma evacuation has no clear effect on mortality in intracerebral haemorrhage

Clinical bottom line (level 1b-)

  1. Patients with intracerebral haemorrhage who were given haematoma evacuation had no clear difference in mortality or Barthel score, than those given the best medical care.
Morgenstern et al: Neurology 1998; 51: 1359-1363
Expires June 2003

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: general hospital, USA

34 patients (aged mean 53 years, 65% male) spontaneous supratentorial intracerebral haemorrhage <9 mL, diagnosed by CT scan

Excluded if
  • intracerebral haemorrhage secondary to known or suspected arteriovenous malformation, aneurysm, brain tumour or head trauma
  • brainstem or cerebellar intracerebral haemorrhage or haemorrhage limited to the thalamus or ventricular system
  • low level function (Rankin score >2) prior to haemorrhage
  • coagulopathy (protime >15 seconds; elevated partial thromboplastin time, platelet count <100,000 per mm ³ ) or current anticoagulant or thrombolytic use within the previous 24 hours
  • serious pre-existing condition that, in the investigator's judgement, increased surgical risk significantly or precluded 6 month survival
  • biopsy-proved amyloid angiopathy
  • haematoma volume of 10 to 19 mL and a Glasgow Coma Scale score of 15, and better than antigravity strength on the affected side
  • ventricular extension >one half of one lateral ventricle or one third of both lateral ventricles


    • Note:
  • 51% of patients were white.


    • Control Group: (n = 17, 17 analysed): best medical therapy- ventricular drainage, osmotic diuretics, sedation, paralysis and hyperventilation to maintain intracranial pressure <21 cm H 2 O. Blood pressure treatment was individualised for each patient.
    Experimental Group: (n = 17, 17 analysed): open craniotomy and haematoma evacuation surgery

    100% followed for 6 months

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNH
    (95% CI)
    mortality 6 months 3
    (17.7%)    		 4
    (23.5%)    		 -33%
    (-408% to 65%)    		 -5.88%
    (-33% to 21.2%)    		 17
    (NNT = 5 to infinity;
    NNH = 3 to infinity)

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    median Barthel score (p=0.33) 55.0
    ()     		65.0
    ()     		-10.0
    ( to )

    Citation

    1. Morgenstern LB, Frankowski RF, Shedden P, et al: Surgical treatment for intracerebral hemorrhage (STICH): A single-centre, randomized clinical trial. Neurology 1998; 51: 1359-1363
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer:

    Clinical Question.
    Patient intracerebral haemorrhagehemorrhage
    Intervention or Exposure surgical clot evacuation
    Comparison no surgery
    Outcome mortality