The Impact of Intervention Modality on Mortality Outcomes in Patients With Hemorrhagic Strokes: A Meta-Analysis
Notice bibliographique
Résumé
INTRODUCTION: Hemorrhagic strokes significantly contribute to stroke-related mortality. Despite advancements in critical care and neuroimaging, optimal management strategies for these strokes remain debated. Medical management focuses on stabilizing physiological parameters and preventing hematoma expansion, whereas surgical evacuation directly addresses mass effect and lowers intracranial pressure (ICP). This meta-analysis evaluates the impact of various intervention modalities and compares surgical versus medical interventions on mortality outcomes in patients with hemorrhagic strokes. MATERIALS AND METHODS: journals. Quality assessment was performed using the Newcastle-Ottawa scale. Randomized and nonrandomized controlled trials, case series and reports, and prospective, observational, and retrospective studies reporting mortality outcomes in patients treated with medical and/or surgical interventions were included. The primary outcome assessed was overall mortality. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Statistical heterogeneity was evaluated using the Q test and I² statistic, while publication bias was assessed using Duval and Tweedie's Trim and Fill method. RESULTS: Seventeen studies, encompassing 9077 patients, were included, with nine evaluating surgical management and eight examining medical management. Pooled analysis showed a modest but statistically significant reduction in mortality across all intervention groups compared with control (p = 0.05; OR: 1.218; 95% CI: 1.000-1.483). Subgroup analysis indicated that surgical interventions significantly decreased mortality compared with medical management (p = 0.009; OR: 1.273; 95% CI: 1.057-1.489), suggesting a survival benefit. In contrast, medical management did not achieve statistical significance (p = 0.606). Moderate heterogeneity was noted (I² = 51.997%), and sensitivity analysis confirmed the robustness of the findings. DISCUSSION: This study shows that surgical and medical management strategies enhance survival in patients with hemorrhagic stroke, with surgical interventions showing a notable mortality advantage, particularly in cases of large hematomas or rapid neurological decline. Advanced surgical methods such as decompressive craniectomy and thrombolysis-assisted evacuation help reduce ICP and secondary brain injury. While medical therapies aim to prevent hematoma expansion, their impact on mortality has been limited. These findings may encourage clinicians to adopt surgical interventions in high-risk patients to optimize outcomes. Moreover, medical management strategies need reevaluation due to their limited effect on mortality. Future research should focus on the timing of interventions and enhancing functional recovery through multidisciplinary rehabilitation. CONCLUSION: This study highlights that both surgical and medical management are critical to improving outcomes in hemorrhagic strokes. Surgical interventions, guided by hematoma characteristics, provide a survival advantage in selected cases. However, individualized treatment planning remains essential, emphasizing the need for optimized medical care, including intensive blood pressure control and comprehensive supportive management.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,013 | 0,025 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,001 |
| Méta-épidémiologie (sens large) | 0,017 | 0,050 |
| Bibliométrie | 0,005 | 0,005 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,001 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».