ReviewCureus2025
The Impact of Intervention Modality on Mortality Outcomes in Patients With Hemorrhagic Strokes: A Meta-Analysis.
Review in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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2 authors.
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Abstract
introductionHemorrhagic strokes significantly contribute to stroke-related mortality. Despite advancements in critical care and neuroimaging, optimal management strategies for these strokes remain debated. Medical management focuses on stabilizing physiological parameters and preventing hematoma expansion, whereas surgical evacuation directly addresses mass effect and lowers intracranial pressure (ICP). This meta-analysis evaluates the impact of various intervention modalities and compares surgical versus medical interventions on mortality outcomes in patients with hemorrhagic strokes. MATERIALS AND
methodsPer the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was conducted on PubMed, BioMed Central, the
resultsSeventeen studies, encompassing 9077 patients, were included, with nine evaluating surgical management and eight examining medical management. Pooled analysis showed a modest but statistically significant reduction in mortality across all intervention groups compared with control (p = 0.05; OR: 1.218; 95% CI: 1.000-1.483). Subgroup analysis indicated that surgical interventions significantly decreased mortality compared with medical management (p = 0.009; OR: 1.273; 95% CI: 1.057-1.489), suggesting a survival benefit. In contrast, medical management did not achieve statistical significance (p = 0.606). Moderate heterogeneity was noted (I² = 51.997%), and sensitivity analysis confirmed the robustness of the findings. DISCUSSION: This study shows that surgical and medical management strategies enhance survival in patients with hemorrhagic stroke, with surgical interventions showing a notable mortality advantage, particularly in cases of large hematomas or rapid neurological decline. Advanced surgical methods such as decompressive craniectomy and thrombolysis-assisted evacuation help reduce ICP and secondary brain injury. While medical therapies aim to prevent hematoma expansion, their impact on mortality has been limited. These findings may encourage clinicians to adopt surgical interventions in high-risk patients to optimize outcomes. Moreover, medical management strategies need reevaluation due to their limited effect on mortality. Future research should focus on the timing of interventions and enhancing functional recovery through multidisciplinary rehabilitation.
conclusionThis study highlights that both surgical and medical management are critical to improving outcomes in hemorrhagic strokes. Surgical interventions, guided by hematoma characteristics, provide a survival advantage in selected cases. However, individualized treatment planning remains essential, emphasizing the need for optimized medical care, including intensive blood pressure control and comprehensive supportive management.
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