The excellent reviewers at The Bottom Line are taking a thorough look at the STITCH (Trauma) trial of 2015. The STITCH (Trauma) trial (Early Surgery versus Initial Conservative Treatment in Patients with Traumatic Intracerebral Hemorrhage) recruited 170 patients into a multicenter RCT to determine whether early surgery (within 12 hours) for traumatic intracerebral haemorrhage would confer a mortality benefit or improved cerebral outcomes, compared with a conservative approach.

The findings of the study did suggest a beneficial effect in patients who underwent early surgery (absolute risk reduction of 10,5%), but this (primary) outcome failed to reach statistical significance.

The Bottom Line conclude in their very worthwhile review:

“Early surgery in TICH cannot be recommended solely on this evidence of a mortality benefit, a larger trial with a patient population generalisable to the UK is needed to explore if early surgery improves functional outcome in TICH”

Read the full text original article by Mendelow et al, published in the Journal of Neurotrauma 2015.