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(Stroke. 2003;34:2597.)
© 2003 American Heart Association, Inc.

Original Contributions

Editorial Comment—International Variations in Surgical Practice for Spontaneous Intracerebral Hemorrhage

Julian T. Hoff, MD, Guest Editor

Taubman Health Care Center, Section of Neurosurgery, University of Michigan, Ann Arbor, Mich

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The international randomized surgical trial for spontaneous intracerebral hemorrhage (STICH) is nearing completion. This article, concerning variations in surgical practice among the countries that participated in the trial, is one of the first of several to emerge from the study headed by Prof David Mendelow. The project has been under way for several years, funded by the Medical Research Council of Great Britain. It involves more than 70 countries including participants from Europe, India, the Far East, North America, and the United Kingdom.

One of the criteria for entry into the study as a participating institution was an agreement to include all patients with intracerebral hemorrhage admitted to hospital, documented on screening logs and submitted monthly to the organizers in Newcastle. However, some centers found this too time-consuming and included only patients they considered appropriate for the trial. Thus, rules for participation were not always followed. Those that did keep logs and submitted them faithfully (42 centers) provided data that are the basis for the study reported here.

One lesson emerging from this study is that patient characteristics such as the Glasgow Coma Scale, the size of the hematoma, the patient’s age, the site of the hematoma, and the depth from the cortical surface are not sufficient to explain which patients had surgery and which did not. Other factors were involved in the decision to operate or not. The authors conclude that differences in the criteria for operation probably were influenced by local custom and surgical training handed down over the years.

Differences . . . [Full Text of this Article]