Meta analyses in treatment of spontaneous supratentorial intracerebral haematoma

Background. None of the randomized controlled trials (RCT) on treatment of Intracerebral haematoma (ICH), definitely shows surgery to be beneficial over conservative treatment alone. Systematic reviews that pooled these RCTs were also inconclusive. This systematic review updates previous meta-analyses, using an alternative manner of reviewing with a criteria list constructed specifically for this type of disease and related interventions. Methods. RCTs and quasi-RCTs (q-RCT) published in English were identified with a systematic literature search. They were evaluated with disease/intervention-specific criteria on comparability between intervention and control group concerning prognostic factors, co-interventions and effect measurement. The resulting selection of studies was compared with those of two earlier systematic reviews. In a meta-analysis selected studies were statistically pooled. Findings. The meta-analysis of surgery versus conservative treatment failed to show a statistically significant reduction in the odds of death (OR: 0.84, 95% CI: 0.67-1.07) in surgically treated patients. Conclusions. Like previous reviews, our disease/intervention-specific methodological evaluation showed no reduction in mortality. Sensitivity analysis demonstrates that the manner in which studies are methodologically evaluated in a systematic review has a great impact on its conclusions.