Background

More than 150,000 patients with head injury are admitted to hospital each year in the UK. Of these about 20,000 are serious. One year after a serious head injury 35% of patients are dead or severely disabled. Intracranial haemorrhage occurs in more than 60% of serious head injuries in one or more of 3 types: extradural, subdural and intraparenchymal. Prompt surgical removal of significant subdural and extradural haemorrhage is of established and widely accepted value. Intraparenchymal haemorrhage is commoner than both the other types put together and is found in more than 40% of severe head injuries. It is clearly associated with a worse outcome but the role for surgical removal remains undefined. Several terms are used to describe the condition including traumatic intraparenchymal haemorrhage, traumatic intracerebral haemorrhage (TICH) and contusion.

We already know that surgery is effective in patients with traumatic EDH and SDH and that early surgery is better than delayed. This is not known for TICH. If early surgery is of benefit to these patients, then implementation of early referral and diagnosis with immediate treatment may reduce death and disability in this specific group of head injured patients. Guidelines for the Surgical Management of Traumatic Brain Injury were published in 2006 in Neurosurgery (58: S2-1-62). These confirm that studies in this area have been observational and there is a lack of Class 1 evidence from well-designed randomised controlled trials. NICE have recommended in the Head Injury Update Full Guideline (2007) that research is needed to develop a consensus on criteria for lesions not currently considered to be surgically significant: namely TICH. This trial (STITCH(TRAUMA)) has been recommended by the latest NICE Head Injury Guideline Development Group. This proposal (STITCH(TRAUMA)) is to evaluate the role of early surgical removal of traumatic intracerebral haematomas.

Further details can be found in the study summary and the protocol.