The significance of crossovers after randomization in the STICH trial
- K. S. M. PrasadAffiliated withRegional Neurosciences Centre, Newcastle General Hospital
- , B. A. GregsonAffiliated withRegional Neurosciences Centre, Newcastle General Hospital
- , P. S. BhattathiriAffiliated withRegional Neurosciences Centre, Newcastle General Hospital
- , P. MitchellAffiliated withRegional Neurosciences Centre, Newcastle General Hospital
- , A. D. MendelowAffiliated withRegional Neurosciences Centre, Newcastle General HospitalDepartment of Neurosurgery, Newcastle General Hospital
Of all forms of stroke, spontaneous intracerebral haemorrhage (ICH) causes the highest morbidity and mortality. The Surgical Trial in Intracerebral Haemorrhage (STICH) found no difference in outcomes between patients randomized to surgical or conservative treatment.
Patients and methods
Of 530 patients randomized to initial conservative treatment, 140 crossed over to surgery. This study examines the variables associated with crossover.
Dominant features of the crossover group were: male, (p = 0.04), right-sided clot (p = 0.03), lobar clot (p = 0.003), clot volume (median 64 mL for crossovers vs. 38 mL for others, p < 0.00001), midline shift (median 6 mm for crossovers vs. 3 mm for others, p > 0.00001), superficial clot (median 1.3 mm for cross-overs vs. 11.5 mm for others, p < 0.00001), and randomization within 12 hours of ictus (p < 0.0005). Thalamic location (p = 0.002) was under-represented. Intraventricular haemorrhage, hydrocephalus, and focal deficits were not associated with crossover. Craniotomy was the method of evacuation in 85% of crossover patients.
Crossover to surgery was more likely when ICH had these features: Right side, lobar location, superficial, large volume, big shift, and early randomization. Crossovers formed a worse prognostic group compared to non-crossovers. Surgery did not affect trial results, which were analyzed by intention-to-treat.
KeywordsCrossover intracerebral haemorrhage surgery
- The significance of crossovers after randomization in the STICH trial
- Book Title
- Brain Edema XIII
- pp 61-64
- Print ISBN
- Online ISBN
- Series Title
- Acta Neurochirurgica Supplementum
- Series Volume
- Series ISSN
- Springer Vienna
- Copyright Holder
- Additional Links
- intracerebral haemorrhage
- Industry Sectors
- eBook Packages
- Editor Affiliations
- 1. Department of Neurosurgery, University of Michigan
- Author Affiliations
- 3. Regional Neurosciences Centre, Newcastle General Hospital, Newcastle Upon Tyne, UK
- 2. Department of Neurosurgery, Newcastle General Hospital, Newcastle Upon Tyne, NE4 6BE, UK
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