|Pooled analysis suggests benefit of catheter-based hematoma removal for intracerebral hemorrhage.
|Year of Publication
|Mandava P, Murthy SB, Shah N, Samson Y, Kimmel M, Kent TA
|2019 04 09
|Age Factors, Aged, Aged, 80 and over, Antihypertensive Agents, Blood Pressure, Catheterization, Cerebral Hemorrhage, Clot Retraction, Female, Fibrinolytic Agents, Hematoma, Hemostatics, Humans, Male, Meta-Analysis as Topic, Middle Aged, Models, Statistical, Neuroprotective Agents, Randomized Controlled Trials as Topic, Treatment Outcome
OBJECTIVE: To develop models of outcome for intracerebral hemorrhage (ICH) to identify promising and futile interventions based on their early phase results without need for correction for baseline imbalances.
METHODS: We developed a pooled outcome model from the control arms of randomized control trials and tested different interventions against the model at comparable baseline conditions. Eligible clinical trials and large case series were identified from multiple library databases. Models based on baseline factors reported in the control arms were tested for the ability to predict functional outcome (modified Rankin Scale score) and mortality. Interventions were grouped into blood pressure control, fibrinolytic-assisted hematoma evacuation, hemostatic medications, and neuroprotective agents. Statistical intervals around the model were generated at the = 0.1 level to screen how each trial's outcome compared to expected outcome.
RESULTS: Fourteen control arms with 3,386 patients were used to develop 7 alternate models for functional outcome. The model incorporating baseline NIH Stroke Scale, age, and hematoma volume yielded the best fit (adjusted = 0.89). All early phase treatments that eventually resulted in negative late phase trials were identified as negative by this method. Early phase fibrinolytic-assisted hematoma evacuation studies showed the most promise trending toward improved functional outcome with no suggestion of an increase in mortality, supporting its further study.
CONCLUSIONS: We successfully developed an outcome model for ICH that identified interventions destined to be negative while identifying a promising one. Such an approach may assist in prioritizing resources prior to multicenter trial.
|PubMed Central ID