Neurology · Surgery · 2 h ago
Right-Sided ICH Was More Often Treated With Neurosurgical Intervention
A post hoc analysis of 3,477 patients with supratentorial intracerebral hemorrhage (ICH) found that right-sided hemorrhages were more likely than left-sided hemorrhages to receive neurosurgical intervention. Despite the difference in intervention rates, 90-day functional outcomes were similar between groups.
- Right-sided ICH was associated with more neurosurgical intervention.
- External ventricular drain placement was also more frequent.
- Ninety-day functional outcomes were similar by hemisphere.
- Residual confounding may explain some treatment differences.
Researchers analyzed data from 3,477 patients with supratentorial ICH enrolled in the prospective ATACH-2 trial and ERICH study. The primary outcome was neurosurgical intervention, including hematoma evacuation, decompressive craniectomy, or other craniotomy. External ventricular drain placement and 90-day functional outcomes were secondary outcomes. Bayesian regression models adjusted for age, admission Glasgow Coma Scale score, ICH location and volume, and intraventricular hemorrhage.
Compared with left-sided ICH, right-sided ICH was associated with higher adjusted odds of neurosurgical intervention (odds ratio, 1.65; 95% credible interval, 1.28–2.14) and external ventricular drain placement (1.22; 1.04–1.44). The direction of the association was consistent across locations, cohorts, and prior model specifications. The analysis found no meaningful difference in 90-day functional outcomes between patients with left- and right-sided ICH.
The findings identify a laterality-associated difference in treatment patterns, not evidence that laterality itself causes different outcomes or should determine care. The authors note that unmeasured anatomic severity and family preferences could have influenced decisions. Prospective research is needed to clarify the factors underlying surgical decision-making.
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Stroke: Association of Hemispheric Laterality With Neurosurgical Intervention in Intracerebral Hemorrhage: A Posthoc Bayesian Analysis of ATACH-2 and ERICH ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.