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class="bkr_bib"><h1 id="_NBK577869_"><span itemprop="name">Evidence review for decompressive hemicraniectomy</span></h1><div class="subtitle">Stroke and transient ischaemic attack in over 16s: diagnosis and initial management</div><p><b>Evidence review H</b></p><p><i>NICE Guideline, No. 128</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Centre (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2019 May</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-3386-0</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div></div><div class="bkr_clear"></div></div><div id="ch8.s1"><h2 id="_ch8_s1_">1. Decompressive hemicraniectomy</h2><div id="ch8.s1.1"><h3>1.1. Review question: Which patients should be referred for decompressive hemicraniectomy?</h3></div><div id="ch8.s1.2"><h3>1.2. Introduction</h3><p>In 2-8% of patients with anterior circulation ischaemic stroke (due to occlusion of the internal carotid, middle cerebral artery, anterior cerebral artery, or a combination of these) large-volume brain infarction causes space-occupying brain swelling (“malignant middle cerebral artery syndrome”) which, untreated, has a mortality of about 80%. Hemicraniectomy (neurosurgical removal of part of the skull to reduce intracerebral pressure) is life-saving. The previous NICE guideline CG68 (2008) recommends referring patients under the age of 60 with a severe stroke syndrome, reduced level of consciousness and a CT-defined infarct of at least 50% of the middle cerebral artery territory, for consideration of hemicraniectomy.</p><p>There remains uncertainty about the net clinical benefit of hemicraniectomy, especially in people with stroke over the age of 60, because it might increase the number of stroke survivors with serious disability to a greater extent than in younger people. Since the last guideline was published, the DESTINY-II randomised trial has reported the effect of hemicraniectomy in patients over the age of 60 years. This review therefore aimed to establish which patients should be referred for decompressive hemicraniectomy, with a focus on patient age.</p></div><div id="ch8.s1.3"><h3>1.3. PICO table</h3><p>For full details see the review protocol in <a href="#ch8.appa">appendix A</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch8tab1"><a href="/books/NBK577869/table/ch8.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figch8tab1" rid-ob="figobch8tab1"><img class="small-thumb" src="/books/NBK577869/table/ch8.tab1/?report=thumb" src-large="/books/NBK577869/table/ch8.tab1/?report=previmg" alt="Table 1. PICO characteristics of review question." /></a><div class="icnblk_cntnt"><h4 id="ch8.tab1"><a href="/books/NBK577869/table/ch8.tab1/?report=objectonly" target="object" rid-ob="figobch8tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of review question. </p></div></div></div><div id="ch8.s1.4"><h3>1.4. Methods and process</h3><p>This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual.<a class="bibr" href="#ch8.ref7" rid="ch8.ref7"><sup>7</sup></a> Methods specific to this review question are described in the review protocol in <a href="#ch8.appa">appendix A</a>.</p><p>Declarations of interest were recorded according to NICE’s 2014 conflicts of interest policy.</p></div><div id="ch8.s1.5"><h3>1.5. Clinical evidence</h3><div id="ch8.s1.5.1"><h4>1.5.1. Included studies</h4><p>Eight studies were included in the review;<a class="bibr" href="#ch8.ref6" rid="ch8.ref6"><sup>6</sup></a><sup>,</sup>
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<a class="bibr" href="#ch8.ref12" rid="ch8.ref12"><sup>12</sup></a><sup>,</sup>
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<a class="bibr" href="#ch8.ref17" rid="ch8.ref17"><sup>17</sup></a><sup>,</sup>
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<a class="bibr" href="#ch8.ref21" rid="ch8.ref21"><sup>21</sup></a><sup>,</sup>
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<a class="bibr" href="#ch8.ref22" rid="ch8.ref22"><sup>22</sup></a><sup>,</sup>
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<a class="bibr" href="#ch8.ref40" rid="ch8.ref40"><sup>40</sup></a><sup>,</sup>
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<a class="bibr" href="#ch8.ref46" rid="ch8.ref46"><sup>46</sup></a><sup>,</sup>
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<a class="bibr" href="#ch8.ref51" rid="ch8.ref51"><sup>51</sup></a> these are summarised in <a class="figpopup" href="/books/NBK577869/table/ch8.tab2/?report=objectonly" target="object" rid-figpopup="figch8tab2" rid-ob="figobch8tab2">Table 2</a> and <a class="figpopup" href="/books/NBK577869/table/ch8.tab3/?report=objectonly" target="object" rid-figpopup="figch8tab3" rid-ob="figobch8tab3">Table 3</a>) below. Evidence from these studies is summarised in the clinical evidence summary below (<a class="figpopup" href="/books/NBK577869/table/ch8.tab4/?report=objectonly" target="object" rid-figpopup="figch8tab4" rid-ob="figobch8tab4">Table 4</a>).</p><p>All the studies are open labelled randomised controlled trials (RCTs), with some having a blinded outcome evaluation (HAMLET<a class="bibr" href="#ch8.ref17" rid="ch8.ref17"><sup>17</sup></a>, HeADDFIRST<a class="bibr" href="#ch8.ref12" rid="ch8.ref12"><sup>12</sup></a>, Zhao<a class="bibr" href="#ch8.ref51" rid="ch8.ref51"><sup>51</sup></a>). It is noted that although open labelled RCTs are the highest quality of study design suitable for these trials, outcomes have been downgraded due to no blinding of patient or care giver and the outcome assessor not being blinded to interventions or the key confounders.</p><p>The studies were stratified according to mean or median age, with three being included in the strata for aged over 60 years. The trial by Slezins<a class="bibr" href="#ch8.ref40" rid="ch8.ref40"><sup>40</sup></a> was downgraded for indirectness due to the age range being 49 to 81 years and not having subgroup analysis of those aged over 60. This review extracted just the subgroup analysis results of those aged over 60 from the trial by Zhao<a class="bibr" href="#ch8.ref51" rid="ch8.ref51"><sup>51</sup></a>, as the median overall age for the population was over 60.</p><p>A Cochrane review<a class="bibr" href="#ch8.ref8" rid="ch8.ref8"><sup>8</sup></a> was identified and all the relevant references have been checked and included where appropriate.</p><p>See also the study selection flow chart in <a href="#ch8.appc">appendix C</a>, study evidence tables in <a href="#ch8.appd">appendix D</a>, forest plots in <a href="#ch8.appe">appendix E</a> and GRADE tables in <a href="#ch8.apph">appendix H</a>.</p></div><div id="ch8.s1.5.2"><h4>1.5.2. Excluded studies</h4><p>See the excluded studies list in <a href="#ch8.apph">appendix H</a>.</p></div><div id="ch8.s1.5.3"><h4>1.5.3. Summary of clinical studies included in the evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch8tab2"><a href="/books/NBK577869/table/ch8.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figch8tab2" rid-ob="figobch8tab2"><img class="small-thumb" src="/books/NBK577869/table/ch8.tab2/?report=thumb" src-large="/books/NBK577869/table/ch8.tab2/?report=previmg" alt="Table 2. Summary of studies included in the evidence review for those aged under 60 years." /></a><div class="icnblk_cntnt"><h4 id="ch8.tab2"><a href="/books/NBK577869/table/ch8.tab2/?report=objectonly" target="object" rid-ob="figobch8tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review for those aged under 60 years. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch8tab3"><a href="/books/NBK577869/table/ch8.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figch8tab3" rid-ob="figobch8tab3"><img class="small-thumb" src="/books/NBK577869/table/ch8.tab3/?report=thumb" src-large="/books/NBK577869/table/ch8.tab3/?report=previmg" alt="Table 3. Summary of studies included in the evidence review for those aged over 60 years." /></a><div class="icnblk_cntnt"><h4 id="ch8.tab3"><a href="/books/NBK577869/table/ch8.tab3/?report=objectonly" target="object" rid-ob="figobch8tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review for those aged over 60 years. </p></div></div><p>See <a href="#ch8.appd">appendix D</a> for full evidence tables.</p></div><div id="ch8.s1.5.4"><h4>1.5.4. Quality assessment of clinical studies included in the evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch8tab4"><a href="/books/NBK577869/table/ch8.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figch8tab4" rid-ob="figobch8tab4"><img class="small-thumb" src="/books/NBK577869/table/ch8.tab4/?report=thumb" src-large="/books/NBK577869/table/ch8.tab4/?report=previmg" alt="Table 4. Clinical evidence summary: Decompressive hemicraniectomy compared to medical treatment for those aged under 60 years." /></a><div class="icnblk_cntnt"><h4 id="ch8.tab4"><a href="/books/NBK577869/table/ch8.tab4/?report=objectonly" target="object" rid-ob="figobch8tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Decompressive hemicraniectomy compared to medical treatment for those aged under 60 years. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch8tab5"><a href="/books/NBK577869/table/ch8.tab5/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img figpopup" rid-figpopup="figch8tab5" rid-ob="figobch8tab5"><img class="small-thumb" src="/books/NBK577869/table/ch8.tab5/?report=thumb" src-large="/books/NBK577869/table/ch8.tab5/?report=previmg" alt="Table 5. Clinical evidence summary: Decompressive hemicraniectomy compared to medical treatment for those over 60 years." /></a><div class="icnblk_cntnt"><h4 id="ch8.tab5"><a href="/books/NBK577869/table/ch8.tab5/?report=objectonly" target="object" rid-ob="figobch8tab5">Table 5</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Decompressive hemicraniectomy compared to medical treatment for those over 60 years. </p></div></div><p>See <a href="#ch8.appf">appendix F</a> for full GRADE tables.</p></div></div><div id="ch8.s1.6"><h3>1.6. Economic evidence</h3><div id="ch8.s1.6.1"><h4>1.6.1. Included studies</h4><p>One health economic study was identified with the relevant comparison and has been included in this review.<a class="bibr" href="#ch8.ref18" rid="ch8.ref18"><sup>18</sup></a> This is summarised in the health economic evidence profile below (<a class="figpopup" href="/books/NBK577869/table/ch8.tab6/?report=objectonly" target="object" rid-figpopup="figch8tab6" rid-ob="figobch8tab6">Table 6</a>) and the health economic evidence table in <a href="#ch8.appi">appendix I</a>.</p></div><div id="ch8.s1.6.2"><h4>1.6.2. Excluded studies</h4><p>No health economic studies that were relevant to this question were excluded due to assessment of limited applicability or methodological limitations.</p><p>See also the health economic study selection flow chart in <a href="#ch8.appg">appendix G</a>.</p></div><div id="ch8.s1.6.3"><h4>1.6.3. Summary of studies included in the economic evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch8tab6"><a href="/books/NBK577869/table/ch8.tab6/?report=objectonly" target="object" title="Table 6" class="img_link icnblk_img figpopup" rid-figpopup="figch8tab6" rid-ob="figobch8tab6"><img class="small-thumb" src="/books/NBK577869/table/ch8.tab6/?report=thumb" src-large="/books/NBK577869/table/ch8.tab6/?report=previmg" alt="Table 6. Health economic evidence profile: surgical decompression versus best medical treatment." /></a><div class="icnblk_cntnt"><h4 id="ch8.tab6"><a href="/books/NBK577869/table/ch8.tab6/?report=objectonly" target="object" rid-ob="figobch8tab6">Table 6</a></h4><p class="float-caption no_bottom_margin">Health economic evidence profile: surgical decompression versus best medical treatment. </p></div></div></div><div id="ch8.s1.6.4"><h4>1.6.4. Unit costs</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch8tab7"><a href="/books/NBK577869/table/ch8.tab7/?report=objectonly" target="object" title="Table 7" class="img_link icnblk_img figpopup" rid-figpopup="figch8tab7" rid-ob="figobch8tab7"><img class="small-thumb" src="/books/NBK577869/table/ch8.tab7/?report=thumb" src-large="/books/NBK577869/table/ch8.tab7/?report=previmg" alt="Table 7. UK costs of non-elective long stay decompressive hemicraniectomy." /></a><div class="icnblk_cntnt"><h4 id="ch8.tab7"><a href="/books/NBK577869/table/ch8.tab7/?report=objectonly" target="object" rid-ob="figobch8tab7">Table 7</a></h4><p class="float-caption no_bottom_margin">UK costs of non-elective long stay decompressive hemicraniectomy. </p></div></div></div></div><div id="ch8.s1.7"><h3>1.7. Resource costs</h3><p>The committee has made a recommendation based on this review (see section <b>Error! R eference source not found.</b>) that decompressive hemicraniectomy should be ‘considered’. The recommendation is not expected to have a substantial impact on resources to the NHS in England.</p><p>The committee noted that where this recommendation is implemented there would be additional costs relating to the increase in the population eligible for decompressive hemicraniectomy compared to current practice. However, the committee agreed that this would not necessarily lead to significantly more people undergoing surgery compared with current practice; not all people eligible for decompressive hemicraneictomy ultimately go on to have surgery following discussions between carers and physicians. The committee noted that more informed discussion of the outcomes following surgery might reduce the uptake of surgery. In addition, the recommendation on endovascular therapy made elsewhere as part of this guideline update (see evidence review D) will increase the population eligible for and provision of endovascular therapy. This is likely to decrease the population referred for decompressive hemicraniectomy.</p></div><div id="ch8.s1.8"><h3>1.8. Evidence statements</h3><div id="ch8.s1.8.1"><h4>1.8.1. Clinical evidence statements</h4><div id="ch8.s1.8.1.1"><h5>1.8.1.1. Aged under 60 years</h5><ul id="l150"><li id="lt472" class="half_rhythm"><div>There was a clinically important benefit of surgery compared to standard care for reduced mortality at 30 days (1 study; n=32; Moderate quality), 6 months (3 studies; n=86; Moderate quality) and 1 year (3 studies; n=134; High quality) and for achieving mRS 0-3 at 6 months (4 studies; n=118; Very Low quality) and 1 year (3 studies; n=134; Low quality).</div></li><li id="lt473" class="half_rhythm"><div>There was no clinically important difference for the SF-36 mental summary score or VAS but a clinically important harm of surgery for the SF-36 physical summary scale (1 study; n=35; Very Low and Low quality).</div></li></ul></div><div id="ch8.s1.8.1.2"><h5>1.8.1.2. Aged over 60 years</h5><ul id="l151"><li id="lt474" class="half_rhythm"><div>There was a clinically important benefit of surgery compared to standard care for reduced mortality at 6 months (1 study; n=29; Moderate quality) and 1 year (3 studies; n=162; Moderate quality) and for achieving mRS 0-3 at 1 year (3 studies; n=165; Very Low quality) but the benefit did not reach clinical significance at 6 months (2 studies; n=141; Very Low quality).</div></li><li id="lt475" class="half_rhythm"><div>Evidence from 1 study in 100 people showed a clinically important benefit of surgery for quality of life at 1 year as measured by the EQ-5D index scale and VAS score (Low quality).</div></li></ul></div></div><div id="ch8.s1.8.2"><h4>1.8.2. Health economic evidence statements</h4><ul id="l152"><li id="lt476" class="half_rhythm"><div>One cost-utility analysis found that decompressive surgery was not cost effective compared with best medical treatment (ICER: £49,224 per QALY gained). This analysis was assessed as partially applicable with potentially serious limitations.</div></li></ul></div></div><div id="ch8.s1.9"><h3>1.9. The committee’s discussion of the evidence</h3><div id="ch8.s1.9.1"><h4>1.9.1. Interpreting the evidence</h4><div id="ch8.s1.9.1.1"><h5>1.9.1.1. The outcomes that matter most</h5><p>The critical outcomes identified for this review were functional outcome (modified Rankin Scale) and mortality at 90 days and 1 year. Both outcomes were considered to be crucial in decision making. Important outcomes included health and social related quality of life (EQ-5D).</p><p>Note that for this review a good functional outcome was defined as a score of 0, 1, 2 or 3 on the mRS because in this population of very severe stroke cases achieving an mRS 3 was agreed to be likely to represent a ‘good’ outcome compared to the expected clinical outcome without surgery.</p></div><div id="ch8.s1.9.1.2"><h5>1.9.1.2. The quality of the evidence</h5><p>Eight RCTs were included in this review, five being categorised into the under 60 years and three in the over 60 years age category. Trials were categorised according to the age range used for their inclusion criteria, where possible, or using the median age and IQR to determine whether the majority of participants were over or under 60 years of age. Some outcomes were only reported by one trial with few participants for each age category, resulting in imprecise effect estimates. Therefore, the committee were not confident that the outcome reflected the true effect. The trials were all open labelled, which meant patients, care givers and outcome assessors were not blinded to the intervention. Three studies however, had a blinded outcome evaluation. As a result, subjective outcomes (mRS and quality of life) were downgraded for risk of bias. Some results for these outcomes were downgraded further if they showed imprecision through estimates of effect having wide confidence intervals. Additionally one study in the over 60 category was further downgraded for an indirect population.</p><p>Evidence ranged from very low to high quality, with the majority of evidence rated as low and moderate quality. The mortality evidence was of high and moderate quality, while the functional outcome data were low and very low quality.</p><p>A published cost utility analysis with a Dutch societal perspective was included in the health economic review and was assessed as partially applicable with potentially serious limitations.</p></div><div id="ch8.s1.9.1.3"><h5>1.9.1.3. Benefits and harms</h5><p>The evidence showed a clear mortality benefit in the short and longer term in those aged both over and under 60 years when decompressive hemicraniectomy is performed compared to medical treatment alone.</p><p>Also, there was a clinically important benefit of surgery for functional outcome (defined as mRS score 0-3) at 6 months and 1 year in those aged under 60 years. However, the committee noted that the benefit was questionable because overall functional outcome was poor. When surgery is performed it results in more patients surviving, but many have poor functional outcomes. To some extent, there is a trade off between reduced mortality but at the expense of overall poor functional outcome. This may be acceptable to a significant proportion of patients. In those aged over 60 years this benefit in the number achieving a ‘good’ functional outcome of 0-3 on the mRS scale was not seen at 6 months follow-up, although a modest clinical benefit was reported at 1 year.</p><p>Quality of life (EQ-5D and SF-36) data were not widely reported and ranged from showing a clinically important benefit of surgery in 1 study of the over 60s, to a clinically important harm of surgery for the physical component score but no clinical difference for the mental summary score or the overall visual analogue score in 1 study in the under 60s. Hemicraniectomy inevitably leads to more people surviving with disability, whereby survivors may have a low quality of life. The committee noted that judging quality of life is variable, subjective and emotionally charged, and perspectives might differ greatly between patients and carers.</p><p>Overall there is good clinical evidence for the benefit of surgery in regards to mortality, with some supporting evidence of improved functional outcomes and variability in the reported impact on quality of life, which was low in both the treated and untreated groups.</p><p>The committee noted that although some of the trials in those aged under 60 years included people who had surgery as long as 96 hours after symptom onset, the benefits in terms of reduced mortality and improved functional outcome appeared to be largely driven by studies which only allowed surgery up to a maximum of 48 hours after onset. Therefore, it was agreed that the reference to surgery being performed within 48 hours of onset should be retained from the original recommendations.</p><p>The committee also reviewed the criteria used to determine eligibility for hemicraniectomy from CG68. It was agreed that these were still appropriate and reflect the populations included in the studies used to inform the new recommendations.</p><p>The decision to have surgery is very individual and some patients may choose not to have surgery if there is a risk of severe disability, whereas others may wish to go ahead based on mortality benefit alone. For this reason the committee chose to leave the recommendation as a ‘consider’ so that it remained an option for management following discussion with suitable patients and their carers. They also recommended discussion about the risks and benefits of surgery. The committee noted that patients would not be able to be involved at the time because of the severity of the stroke, so the family members or carers would be responsible for making the decision. In deciding whether to opt for surgery considerations should include individual wishes and preferences and the pre-stroke functional status, as surgery would not be appropriate for people with severe disability before stroke. The high likelihood of residual moderate or severe disability after surgery should be made clear.</p></div></div><div id="ch8.s1.9.2"><h4>1.9.2. Cost effectiveness and resource use</h4><p>The results of a published cost utility analysis with a Dutch societal perspective found that decompressive surgery is not cost effective compared with best medical treatment in adults aged 60 or younger with space-occupying hemispheric infarction.<a class="bibr" href="#ch8.ref18" rid="ch8.ref18"><sup>18</sup></a> The study estimated the lifetime incremental cost effectiveness ratio to be £49,224 per quality adjusted life year gained. At three years, decompressive surgery had a 2% likelihood of being cost effective at an £66,961 (€80,000) per QALY gained willingness to pay threshold. Although this economic evidence did not support decompressive hemicraniectomy the committee was not confident that it was sufficiently robust to make a strong recommendation not to offer decompressive hemicraniectomy, due to its partial applicability and potentially serious limitations.</p><p>To aid the committee’s discussion of the economic evidence, the most appropriate UK NHS reference costs corresponding to the unit costs used in the study were combined with the resource usage over three years reported for the within-trial phase of the study. This allowed calculation of a three-year incremental cost for surgical decompression over best medical treatment of £90,886. The study reported an incremental QALY difference of 1.0 QALYs over the three year within-trial period. Using the estimate of UK incremental costs, the three year ICER generated is £90,886 per QALY gained. The lifetime incremental QALY difference reported in the study was 4.2 QALYs. At a £20,000 per QALY gained willingness to pay threshold, the lifetime incremental cost of surgical decompression would need to be <£84,000 to be considered cost effective. As this value is less than the three year incremental cost, this scenario is highly unlikely as there are additional continuing incremental costs after three years. However,the committee expressed concerns about some of the resource usage reported in the study. Zero days in the nursing home were reported in the ‘best medical treatment’ arm, which the committee considered highly unlikely to be representative of this population and therefore of very limited applicability to the UK setting. Higher nursing home resource usage in the ‘best medical treatment’ arm would increase the total cost of ‘best medical treatment’ and reduce the incremental cost difference between ‘best medical treatment’ and ‘decompressive hemicraniectomy’. This would result in a lower incremental cost effectiveness ratio. Although there still remains uncertainty regarding the cost effectiveness of decompressive hemicraniectomy, undertaking a <i>de novo</i> analysis from a UK perspective was not considered likely to reduce this uncertainty, as the resource use reported in the identified study still remains the only published resource use data, therefore a new model would be based on tenuous assumptions.</p><p>In addition, the committee noted that in the under 60 population, the only quality of life data available were from the HAMLET trial, on which the Dutch societal cost utility analysis was based. For the outcome ‘functional outcome score 0-3 mRS at 1 year’, the HAMLET trial has a much smaller effect size than in the DESTINY and DECIMAL trials, which show a trend towards benefit of decompressive hemicraniectomy. Quality of life reported by the HAMLET trial might therefore be expected to be lower than in the other trials. If quality of life data were available from all the trials, the ICER might be improved. Overall, the clinical evidence identified a modest improvement in functional outcome which the committee deemed was clinically important. Despite this slight improvement, functional outcome is poor in this population. Regardless of the limited applicability of the one identified economic study, decompressive hemicraniectomy significantly reduces mortality, while most of the survivors have significant neurological impairment and disability which limits their functional ability. Many people will need ongoing and costly long term nursing care. The committee agreed that considerations other than cost effectiveness were relevant to this issue. The clear mortality benefit of decompressive hemicraniectomy was expected to be important to many people with stroke, their families, and carers, irrespective of the poor functional outcomes of surgery. The committee discussed that the decision to undergo surgery warrants careful discussion between stroke physicians, surgeons, people with stroke and their families and carers. These shared decisions should be made on a case by case basis.</p><p>No health economic evidence was identified that considered the cost effectiveness of decompressive hemicraniectomy in people aged over 60. In the over 60 population, quality of life measured on the EQ-5D index and visual analogue scales was reported at 1 year by the DESTINY II trial. Both measures showed an improved quality of life for people undergoing decompressive hemicraniectomy compared with best medical treatment, though baseline quality of life was low. The clinical evidence did not show a differential effect between the over 60 and under 60 population and so, for equity reasons, the restriction of the population eligible for decompressive hemicraniectomy to those under 60 years of age is not supported. Due to the poor, though slightly improved functional outcomes after the surgery, the decision regarding whether a person should have a decompressive hemicraniectomy is a shared decision, to be made in conjunction with individuals, families and carers. In current practice, around 5% of people with stroke undergo decompressive hemicraniectomy. The committee acknowledged that extending the population eligible for surgery is a change to current practice, noting that people aged over 60 will generally take longer to recover from surgery and may therefore accrue higher rehabilitation costs. Without an age cut off, other factors will still be taken into consideration when determining whether a person is suitable for surgery. The committee agreed that increasing the population eligible for decompressive hemicraniectomy would not necessarily lead to significantly more people undergoing surgery; not all people eligible for decompressive hemicraneictomy ultimately go on to have surgery following discussions between carers and physicians. The committee noted that more informed discussion of the outcomes following surgery might reduce the uptake of surgery. In addition, the recommendation on endovascular therapy made elsewhere as part of this guideline update (see evidence review D) will increase the population eligible for endovascuar therapy and increase provision of endovascular therapy. This is likely to decrease the population referred for decompressive hemicraniectomy. The committee therefore does not expect this recommendation to have a substantial resource impact on the NHS in England.</p><p>In conclusion, the committee thought that the cost effectiveness of decompressive hemicraniectomy remains uncertain. The committee recommended that decompressive hemicraniectomy be considered for some patients, following shared decision making between physicians, surgeons, families and carers. This recommendation was made based on consideration of the clear mortality benefit of decompressive hemicraniectomy, which the committee thought would be important to a significant proportion of the population, irrespective of the overall limited improvement in functional outcome following surgery.</p></div><div id="ch8.s1.9.3"><h4>1.9.3. Other factors the committee took into account</h4><p>The evidence did not support the use of an age cut-off for surgery and therefore the age cut-off had been removed from the recommendation. The committee considered that the patients’ pre-morbid state was much more relevant than age as a marker of potential outcome with and without surgery that would help decision making.</p><p>The committee discussed that, aside from removing the age cut-off, the weight of evidence was not strong enough either way to change the recommendation from consider.</p><p>It was noted that deciding to have surgery is a very difficult decision and patients should be provided with data of functional outcomes to guide their decision. The committee decided that patients or their carers should be given specific information on the risks and benefits in terms of their functional outcomes and risk of mortality. The decision should be made between the patient, their carers and medical or surgical team.</p><p>The committee took into account that the definition of a ‘good’ functional outcome will vary on an individual patient basis, as while one person might prefer to be alive with a functional score of 5, another might think this is an unacceptable state, potentially worse than death.</p><p>The committee were also aware of some limited evidence that decompressive hemicraniectomy may be performed beyond 48 hours.</p></div></div></div><div id="ch8.rl.r1"><h2 id="_ch8_rl_r1_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="ch8.ref1">Alexander
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P, Heels-Ansdell
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D, Siemieniuk
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R, Bhatnagar
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N, Chang
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Y, Fei
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Y
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et al. Hemicraniectomy versus medical treatment with large MCA infarct: a review and meta-analysis. BMJ Open. 2016; 6(11):e014390 [<a href="/pmc/articles/PMC5168488/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5168488</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27884858" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27884858</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="ch8.ref2">Ayling
|
|
OGS, Alotaibi
|
|
NM, Wang
|
|
JZ, Fatehi
|
|
M, Ibrahim
|
|
GM, Benavente
|
|
O
|
|
et al. Suboccipital decompressive craniectomy for cerebellar infarction: A systematic review and meta-analysis. World Neurosurgery. 2018; 110:450–459.e5 [<a href="https://pubmed.ncbi.nlm.nih.gov/29104155" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29104155</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="ch8.ref3">Back
|
|
L, Nagaraja
|
|
V, Kapur
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|
A, Eslick
|
|
GD. Role of decompressive hemicraniectomy in extensive middle cerebral artery strokes: a meta-analysis of randomised trials. Internal Medicine Journal. 2015; 45(7):711–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/25684396" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25684396</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>4.</dt><dd><div class="bk_ref" id="ch8.ref4">Buskens
|
|
E, Nederkoorn
|
|
PJ, Buijs-Van Der Woude
|
|
T, Mali
|
|
WP, Kappelle
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LJ, Eikelboom
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BC
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et al. Imaging of carotid arteries in symptomatic patients: cost-effectiveness of diagnostic strategies. Radiology. 2004; 233(1):101–12 [<a href="https://pubmed.ncbi.nlm.nih.gov/15333770" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15333770</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>5.</dt><dd><div class="bk_ref" id="ch8.ref5">Cho
|
|
DY, Chen
|
|
TC, Lee
|
|
HC. Ultra-early decompressive craniectomy for malignant middle cerebral artery infarction. Surgical Neurology. 2003; 60(3):227–32; discussion 232-3 [<a href="https://pubmed.ncbi.nlm.nih.gov/12922040" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12922040</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>6.</dt><dd><div class="bk_ref" id="ch8.ref6">Chua
|
|
AE, Jamora
|
|
RD. Hemicraniectomy for Malignant Middle Cerebral Artery Infarction (HeMMI): A randomized controlled clinical trial of decompressive hemicraniectomy with standardized medical care versus standardized medical care alone. Acta Medica Philippina. 2015; 49(1):28–33</div></dd></dl><dl class="bkr_refwrap"><dt>7.</dt><dd><div class="bk_ref" id="ch8.ref7">Chung
|
|
H, Refoios Camejo
|
|
R, Barnett
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D. Alteplase for the treatment of acute ischaemic stroke: NICE technology appraisal guidance. Heart. 2007; 93(12):1616–7 [<a href="/pmc/articles/PMC2095758/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2095758</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18003692" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18003692</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>8.</dt><dd><div class="bk_ref" id="ch8.ref8">Cruz-Flores
|
|
S, Berge
|
|
E, Whittle
|
|
IR. Surgical decompression for cerebral oedema in acute ischaemic stroke. Cochrane Database of Systematic Reviews
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|
2012, Issue 1. Art. No.: CD003435. DOI: 10.1002/14651858.CD003435.pub2. [<a href="https://pubmed.ncbi.nlm.nih.gov/22258954" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22258954</span></a>] [<a href="http://dx.crossref.org/10.1002/14651858.CD003435.pub2" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></dd></dl><dl class="bkr_refwrap"><dt>9.</dt><dd><div class="bk_ref" id="ch8.ref9">Delgado-López
|
|
P, Mateo-Sierra
|
|
O, García-Leal
|
|
R, Agustín-Gutiérrez
|
|
F, Fernández-Carballal
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C, Carrillo-Yagüe
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R. Decompressive craniectomy in malignant infarction of the middle cerebral artery. Neurocirugia. 2004; 15(1):43–55 [<a href="https://pubmed.ncbi.nlm.nih.gov/15039849" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15039849</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>10.</dt><dd><div class="bk_ref" id="ch8.ref10">Dhand
|
|
A, Landau
|
|
WM, Kelly
|
|
AG, Holloway
|
|
RG, Jaeschke
|
|
R, Juettler
|
|
E. Hemicraniectomy for middle-cerebral-artery stroke. New England Journal of Medicine. 2014; 370(24):2346–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/24918381" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24918381</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>11.</dt><dd><div class="bk_ref" id="ch8.ref11">Elsawaf
|
|
A, Galhom
|
|
A. Decompressive craniotomy for malignant middle cerebral artery infarction: Optimal timing and literature review. World Neurosurgery. 2018; 116:e71–e78 [<a href="https://pubmed.ncbi.nlm.nih.gov/29653270" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29653270</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>12.</dt><dd><div class="bk_ref" id="ch8.ref12">Frank
|
|
JI, Schumm
|
|
LP, Wroblewski
|
|
K, Chyatte
|
|
D, Rosengart
|
|
AJ, Kordeck
|
|
C
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et al. Hemicraniectomy and durotomy upon deterioration from infarction-related swelling trial: randomized pilot clinical trial. Stroke. 2014; 45(3):781–7 [<a href="/pmc/articles/PMC4033520/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4033520</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24425122" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24425122</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>13.</dt><dd><div class="bk_ref" id="ch8.ref13">Georgiadis
|
|
D, Schwarz
|
|
S, Aschoff
|
|
A, Schwab
|
|
S. Hemicraniectomy and moderate hypothermia in patients with severe ischemic stroke. Stroke. 2002; 33:1584–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/12052995" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12052995</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>14.</dt><dd><div class="bk_ref" id="ch8.ref14">Geurts
|
|
M, van der Worp
|
|
HB, Kappelle
|
|
LJ, Amelink
|
|
GJ, Algra
|
|
A, Hofmeijer
|
|
J
|
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et al. Surgical decompression for space-occupying cerebral infarction: outcomes at 3 years in the randomized HAMLET trial. Stroke. 2013; 44(9):2506–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/23868265" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23868265</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>15.</dt><dd><div class="bk_ref" id="ch8.ref15">Gupta
|
|
R, Connolly
|
|
ES, Mayer
|
|
S, Elkind
|
|
MS. Hemicraniectomy for massive middle cerebral artery territory infarction: a systematic review. Stroke. 2004; 35(2):539–43 [<a href="https://pubmed.ncbi.nlm.nih.gov/14707232" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14707232</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>16.</dt><dd><div class="bk_ref" id="ch8.ref16">Hofmeijer
|
|
J, Algra
|
|
A, Gijn
|
|
J, Amelink
|
|
GJ, Kappelle
|
|
LJ, Worp
|
|
HB. HAMLET: hemicraniectomy after middle cerebral artery infarction with life-threatening oedema trial. International Journal of Stroke. 2008; 3:(Suppl 1):81</div></dd></dl><dl class="bkr_refwrap"><dt>17.</dt><dd><div class="bk_ref" id="ch8.ref17">Hofmeijer
|
|
J, Kappelle
|
|
LJ, Algra
|
|
A, Amelink
|
|
GJ, van Gijn
|
|
J, van der Worp
|
|
HB
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et al. Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurology. 2009; 8(4):326–33 [<a href="https://pubmed.ncbi.nlm.nih.gov/19269254" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19269254</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>18.</dt><dd><div class="bk_ref" id="ch8.ref18">Hofmeijer
|
|
J, van der Worp
|
|
HB, Kappelle
|
|
LJ, Eshuis
|
|
S, Algra
|
|
A, Greving
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JP
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et al. Cost-effectiveness of surgical decompression for space-occupying hemispheric infarction. Stroke. 2013; 44(10):2923–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/23943217" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23943217</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>19.</dt><dd><div class="bk_ref" id="ch8.ref19">Inamasu
|
|
J, Kaito
|
|
T, Watabe
|
|
T, Ganaha
|
|
T, Yamada
|
|
Y, Tanaka
|
|
T
|
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et al. Decompressive hemicraniectomy for malignant hemispheric stroke in the elderly: comparison of outcomes between individuals 61-70 and >70 years of age. Journal of Stroke and Cerebrovascular Diseases. 2013; 22(8):1350–4 [<a href="https://pubmed.ncbi.nlm.nih.gov/23489954" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23489954</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>20.</dt><dd><div class="bk_ref" id="ch8.ref20">Juttler
|
|
E, Bosel
|
|
J, Amiri
|
|
H, Schiller
|
|
P, Limprecht
|
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R, Hacke
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W
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et al. DESTINY II: Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery II. International Journal of Stroke. 2011; 6(1):79–86 [<a href="https://pubmed.ncbi.nlm.nih.gov/21205246" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21205246</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>21.</dt><dd><div class="bk_ref" id="ch8.ref21">Juttler
|
|
E, Schwab
|
|
S, Schmiedek
|
|
P, Unterberg
|
|
A, Hennerici
|
|
M, Woitzik
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J
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et al. Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY): a randomized, controlled trial. Stroke. 2007; 38(9):2518–25 [<a href="https://pubmed.ncbi.nlm.nih.gov/17690310" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17690310</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>22.</dt><dd><div class="bk_ref" id="ch8.ref22">Juttler
|
|
E, Unterberg
|
|
A, Woitzik
|
|
J, Bosel
|
|
J, Amiri
|
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H, Sakowitz
|
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OW
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|
et al. Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. New England Journal of Medicine. 2014; 370(12):1091–100 [<a href="https://pubmed.ncbi.nlm.nih.gov/24645942" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24645942</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>23.</dt><dd><div class="bk_ref" id="ch8.ref23">Kamran
|
|
S, Akhtar
|
|
N, Salam
|
|
A, Alboudi
|
|
A, Rashid
|
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H, Kamran
|
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K
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et al. Decompressive hemicraniectomy for malignant middle cerebral artery stroke: South Asian experience. Journal of Stroke and Cerebrovascular Diseases. 2017; 26(10):2306–12 [<a href="https://pubmed.ncbi.nlm.nih.gov/28579508" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28579508</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>24.</dt><dd><div class="bk_ref" id="ch8.ref24">Khoozestan
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A. Comparison of hemicraniectomy and conservative management on short term prognosis of patients with stem of middle cerebral artery infarction, admitted in ahvaz golestan hospital [IRCT201112018272N1]. 2012. Available from: <a href="http://en.irct.ir/trial/8695" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://en<wbr style="display:inline-block"></wbr>​.irct.ir/trial/8695</a> Last accessed: 14/08/2018.</div></dd></dl><dl class="bkr_refwrap"><dt>25.</dt><dd><div class="bk_ref" id="ch8.ref25">Li
|
|
YP, Hou
|
|
MZ, Lu
|
|
GY, Ciccone
|
|
N, Wang
|
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XD, Dong
|
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L
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et al. Neurologic functional outcomes of decompressive hemicraniectomy versus conventional treatment for malignant middle cerebral artery infarction: A systematic review and meta-analysis. World Neurosurgery. 2017; 99:709–25.e3 [<a href="https://pubmed.ncbi.nlm.nih.gov/28024976" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28024976</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>26.</dt><dd><div class="bk_ref" id="ch8.ref26">Lin
|
|
TK, Chen
|
|
SM, Huang
|
|
YC, Chen
|
|
PY, Chen
|
|
MC, Tsai
|
|
HC
|
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et al. The outcome predictors of malignant large infarction and the functional outcome of survivors following decompressive craniectomy. World Neurosurgery. 2016; 93:133–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/27297245" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27297245</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>27.</dt><dd><div class="bk_ref" id="ch8.ref27">Lu
|
|
X, Huang
|
|
B, Zheng
|
|
J, Tao
|
|
Y, Yu
|
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W, Tang
|
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L
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et al. Decompressive craniectomy for the treatment of malignant infarction of the middle cerebral artery. Scientific Reports. 2014; 4:7070 [<a href="/pmc/articles/PMC4233335/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4233335</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25400113" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25400113</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>28.</dt><dd><div class="bk_ref" id="ch8.ref28">Lucas
|
|
C, Thines
|
|
L, Dumont
|
|
F, Leclerc
|
|
X, Riegel
|
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B, Cordonnier
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C
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et al. Decompressive surgery for malignant middle cerebral artery infarcts: the results of randomized trials can be reproduced in daily practice. European Neurology. 2012; 68(3):145–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/22832365" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22832365</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>29.</dt><dd><div class="bk_ref" id="ch8.ref29">Macleod
|
|
M, Hofmeijer
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|
J, Gijn
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J, Worp
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|
HB. Hemicraniectomy After Middle cerebral artery infarction with Life-threatening Edema Trial (HAMLET: iSRCTN94237756). UK Stroke Forum Conference 2006. 2006;</div></dd></dl><dl class="bkr_refwrap"><dt>30.</dt><dd><div class="bk_ref" id="ch8.ref30">McKenna
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A, Wilson
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CF, Caldwell
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|
SB, Curran
|
|
D. Functional outcomes of decompressive hemicraniectomy following malignant middle cerebral artery infarctions: a systematic review. British Journal of Neurosurgery. 2012; 26(3):310–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/22320444" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22320444</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>31.</dt><dd><div class="bk_ref" id="ch8.ref31">Mohan Rajwani
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K, Crocker
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M, Moynihan
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|
B. Decompressive craniectomy for the treatment of malignant middle cerebral artery infarction. British Journal of Neurosurgery. 2017; 31(4):401–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/28604106" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28604106</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>32.</dt><dd><div class="bk_ref" id="ch8.ref32">National Institute for Health and Care Excellence. Developing NICE guidelines: the manual. London. National Institute for Health and Care Excellence, 2014. Available from: <a href="http://www.nice.org.uk/article/PMG20/chapter/1%20Introduction%20and%20overview" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.nice.org.uk<wbr style="display:inline-block"></wbr>​/article/PMG20/chapter<wbr style="display:inline-block"></wbr>​/1%20Introduction%20and%20overview</a> [<a href="https://pubmed.ncbi.nlm.nih.gov/26677490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26677490</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>33.</dt><dd><div class="bk_ref" id="ch8.ref33">Neugebauer
|
|
H, Heuschmann
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PU, Juttler
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|
E. Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery - Registry (DESTINY-R): design and protocols. BMC Neurology. 2012; 12:115 [<a href="/pmc/articles/PMC3517444/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3517444</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23031451" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23031451</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>34.</dt><dd><div class="bk_ref" id="ch8.ref34">Omay
|
|
SB, Carrion-Grant
|
|
GM, Kuzmik
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|
GA, Fu
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M, Grant
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R, Schindler
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JL
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et al. Decompressive hemicraniectomy for ischemic stroke in the pediatric population. Neurosurgical Review. 2013; 36(1):21–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/22886322" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22886322</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>35.</dt><dd><div class="bk_ref" id="ch8.ref35">Organisation for Economic Co-operation and Development (OECD). Purchasing power parities (PPP). 2017. Available from: <a href="http://www.oecd.org/sdd/prices-ppp/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.oecd.org/sdd/prices-ppp/</a> Last accessed: 2/2/2018.</div></dd></dl><dl class="bkr_refwrap"><dt>36.</dt><dd><div class="bk_ref" id="ch8.ref36">Pledl
|
|
HW, Hoyer
|
|
C, Rausch
|
|
J, Ebert
|
|
AD, Seiz
|
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M, Arp
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M
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et al. Decompressive hemicraniectomy in malignant middle cerebral artery infarction: The ‘real world’ beyond studies. European Neurology. 2016; 76(1-2):48–56 [<a href="https://pubmed.ncbi.nlm.nih.gov/27379413" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27379413</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>37.</dt><dd><div class="bk_ref" id="ch8.ref37">Post
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PN, Stiggelbout
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AM, Wakker
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PP. The utility of health states after stroke: a systematic review of the literature. Stroke. 2001; 32(6):1425–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/11387509" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11387509</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>38.</dt><dd><div class="bk_ref" id="ch8.ref38">Schwab
|
|
S, Rieke
|
|
K, Krieger
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|
D, Hund
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E, Aschoff
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A, Kummer
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R
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et al. Craniectomy in space-occupying middle cerebral artery infarcts. Der nervenarzt. 1995; 66(6):430–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/7543659" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7543659</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>39.</dt><dd><div class="bk_ref" id="ch8.ref39">Sengeze
|
|
N, Kutlahan
|
|
S, Karaslan
|
|
T. Comparison of the decompressive surgery and medical therapy only results in malignant middle cerebral artery infarction. International Journal of Stroke. 2014; 9:(Suppl 3):96</div></dd></dl><dl class="bkr_refwrap"><dt>40.</dt><dd><div class="bk_ref" id="ch8.ref40">Slezins
|
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J, Keris
|
|
V, Bricis
|
|
R, Millers
|
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A, Valeinis
|
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E, Stukens
|
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J
|
|
et al. Preliminary results of randomized controlled study on decompressive craniectomy in treatment of malignant middle cerebral artery stroke. Medicina. 2012; 48(10):521–4 [<a href="https://pubmed.ncbi.nlm.nih.gov/23324248" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23324248</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>41.</dt><dd><div class="bk_ref" id="ch8.ref41">Streib
|
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CD, Hartman
|
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LM, Molyneaux
|
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BJ. Early decompressive craniectomy for malignant cerebral infarction: Meta-analysis and clinical decision algorithm. Neurology Clinical Practice. 2016; 6(5):433–43 [<a href="/pmc/articles/PMC5100704/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5100704</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27847685" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27847685</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>42.</dt><dd><div class="bk_ref" id="ch8.ref42">Vahedi
|
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K. Decompressive hemicraniectomy for malignant hemispheric infarction. Current Treatment Options in Neurology. 2009; 11(2):113–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/19210913" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19210913</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>43.</dt><dd><div class="bk_ref" id="ch8.ref43">Vahedi
|
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K, Bousser
|
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MG. DECIMAL. Decompressive craniectomy in malignant middle cerebral artery infarcts [NCT00190203]. 2004. Available from: <a href="https://clinicaltrials.gov/show/NCT00190203" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://clinicaltrials.gov/show/NCT00190203</a> Last accessed: 14/08/2018. Stroke and transient ischaemic attack in over 16s: evidence review H FINAL (May 2019) Decompressive hemicraniectomy</div></dd></dl><dl class="bkr_refwrap"><dt>44.</dt><dd><div class="bk_ref" id="ch8.ref44">Vahedi
|
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K, Hofmeijer
|
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J, Juettler
|
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E, Vicaut
|
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E, George
|
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B, Algra
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A
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et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurology. 2007; 6(3):215–22 [<a href="https://pubmed.ncbi.nlm.nih.gov/17303527" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17303527</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>45.</dt><dd><div class="bk_ref" id="ch8.ref45">Vahedi
|
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K, Vicaut
|
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E, Blanquet
|
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A, Payen
|
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D, Bousser
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MG. Decimal trial: decompressive craniectomy in malignant middle cerebral artery infarcts: a sequential design, multicenter, randomized, controlled trial. International Stroke Conference 2005, New Orleans, Louisiana, February 2-4, 2005. 2005;</div></dd></dl><dl class="bkr_refwrap"><dt>46.</dt><dd><div class="bk_ref" id="ch8.ref46">Vahedi
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K, Vicaut
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E, Mateo
|
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J, Kurtz
|
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A, Orabi
|
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M, Guichard
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JP
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et al. Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke. 2007; 38(9):2506–17 [<a href="https://pubmed.ncbi.nlm.nih.gov/17690311" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17690311</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>47.</dt><dd><div class="bk_ref" id="ch8.ref47">van Middelaar
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T, Nederkoorn
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PJ, van der Worp
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HB, Stam
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J, Richard
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E. Quality of life after surgical decompression for space-occupying middle cerebral artery infarction: systematic review. International Journal of Stroke. 2015; 10(2):170–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/25042345" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25042345</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>48.</dt><dd><div class="bk_ref" id="ch8.ref48">Vibbert
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M, Mayer
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SA. Early decompressive hemicraniectomy following malignant ischemic stroke: the crucial role of timing. Current Neurology and Neuroscience Reports. 2010; 10(1):1–3 [<a href="https://pubmed.ncbi.nlm.nih.gov/20425217" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20425217</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>49.</dt><dd><div class="bk_ref" id="ch8.ref49">Worp
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HB. Hemicraniectomy after middle cerebral artery infarction with life-threatening edema trial. Trials. 2006; 7(29) [<a href="/pmc/articles/PMC1570365/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1570365</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16965617" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16965617</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>50.</dt><dd><div class="bk_ref" id="ch8.ref50">Yang
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MH, Lin
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HY, Fu
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J, Roodrajeetsing
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G, Shi
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SL, Xiao
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SW. Decompressive hemicraniectomy in patients with malignant middle cerebral artery infarction: A systematic review and meta-analysis. Surgeon Journal of the Royal Colleges of Surgeons of Edinburgh & Ireland. 2015; 13(4):230–40 [<a href="https://pubmed.ncbi.nlm.nih.gov/25661677" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25661677</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>51.</dt><dd><div class="bk_ref" id="ch8.ref51">Zhao
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J, Su
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YY, Zhang
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Y, Zhang
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YZ, Zhao
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R, Wang
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L
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et al. Decompressive hemicraniectomy in malignant middle cerebral artery infarct: a randomized controlled trial enrolling patients up to 80 years old. Neurocritical Care. 2012; 17(2):161–71 [<a href="https://pubmed.ncbi.nlm.nih.gov/22528280" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22528280</span></a>]</div></dd></dl></dl></div><div id="appendixesappgroup8"><h2 id="_appendixesappgroup8_">Appendices</h2><div id="ch8.appa"><h3>Appendix A. Review protocols</h3><p id="ch8.appa.tab1"><a href="/books/NBK577869/table/ch8.appa.tab1/?report=objectonly" target="object" rid-ob="figobch8appatab1" class="figpopup">Table 7. Review protocol: Decompressive hemicraniectomy</a></p><p id="ch8.appa.tab2"><a href="/books/NBK577869/table/ch8.appa.tab2/?report=objectonly" target="object" rid-ob="figobch8appatab2" class="figpopup">Table 8. Health economic review protocol</a></p></div><div id="ch8.appb"><h3>Appendix B. Literature search strategies</h3><p>The literature searches for this review are detailed below and complied with the methodology outlined in Developing NICE guidelines: the manual 2014, updated 2017 <a href="https://www.nice.org.uk/guidance/pmg20/resources/developing-nice-guidelines-the-manual-pdf-72286708700869" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.nice.org.uk/guidance/pmg20/resources/developing-nice-guidelines-the-manual-pdf-72286708700869</a></p><p><i>For more detailed information, please see the</i> Methodology <i>Review</i>.</p><div id="ch8.appb.s1"><h4>B.1. Clinical search literature search strategy</h4><p>Searches were constructed using a PICO framework where population (P) terms were combined with Intervention (I) and in some cases Comparison (C) terms. Outcomes (O) are rarely used in search strategies for interventions as these concepts may not be well described in title, abstract or indexes and therefore difficult to retrieve. Search filters were applied to the search where appropriate.</p><p id="ch8.appb.tab1"><a href="/books/NBK577869/table/ch8.appb.tab1/?report=objectonly" target="object" rid-ob="figobch8appbtab1" class="figpopup">Table 9. Database date parameters and filters used</a></p><p id="ch8.appb.tab2"><a href="/books/NBK577869/table/ch8.appb.tab2/?report=objectonly" target="object" rid-ob="figobch8appbtab2" class="figpopup">Medline (Ovid) search terms</a></p><p id="ch8.appb.tab3"><a href="/books/NBK577869/table/ch8.appb.tab3/?report=objectonly" target="object" rid-ob="figobch8appbtab3" class="figpopup">Embase (Ovid) search terms</a></p><p id="ch8.appb.tab4"><a href="/books/NBK577869/table/ch8.appb.tab4/?report=objectonly" target="object" rid-ob="figobch8appbtab4" class="figpopup">Cochrane Library (Wiley) search terms</a></p></div><div id="ch8.appb.s2"><h4>B.2. Health Economics literature search strategy</h4><p>Health economic evidence was identified by conducting a broad search relating to the stroke population in NHS Economic Evaluation Database (NHS EED – this ceased to be updated after March 2015) and the Health Technology Assessment database (HTA) with no date restrictions. NHS EED and HTA databases are hosted by the Centre for Research and Dissemination (CRD). Additional searches were run on Medline and Embase for health economics.</p><p id="ch8.appb.tab5"><a href="/books/NBK577869/table/ch8.appb.tab5/?report=objectonly" target="object" rid-ob="figobch8appbtab5" class="figpopup">Table 10. Database date parameters and filters used</a></p><p id="ch8.appb.tab6"><a href="/books/NBK577869/table/ch8.appb.tab6/?report=objectonly" target="object" rid-ob="figobch8appbtab6" class="figpopup">Medline (Ovid) search terms</a></p><p id="ch8.appb.tab7"><a href="/books/NBK577869/table/ch8.appb.tab7/?report=objectonly" target="object" rid-ob="figobch8appbtab7" class="figpopup">Embase (Ovid) search terms</a></p><p id="ch8.appb.tab8"><a href="/books/NBK577869/table/ch8.appb.tab8/?report=objectonly" target="object" rid-ob="figobch8appbtab8" class="figpopup">NHS EED and HTA (CRD) search terms</a></p></div></div><div id="ch8.appc"><h3>Appendix C. Clinical evidence selection</h3><p id="ch8.appc.fig1"><a href="/books/NBK577869/figure/ch8.appc.fig1/?report=objectonly" target="object" rid-ob="figobch8appcfig1" class="figpopup">Figure 1. Flow chart of clinical study selection for the review of decompressive hemicraniectomy</a></p></div><div id="ch8.appd"><h3>Appendix D. Clinical evidence tables</h3><p id="ch8.appd.et1"><a href="/books/NBK577869/bin/ch8-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (338K)</span></p></div><div id="ch8.appe"><h3>Appendix E. Forest plots and ordinal shift graphs</h3><div id="ch8.appe.s1"><h4>E.1. Decompressive hemicraniectomy vs medical treatment in those under 60 years</h4><p id="ch8.appe.fig1"><a href="/books/NBK577869/figure/ch8.appe.fig1/?report=objectonly" target="object" rid-ob="figobch8appefig1" class="figpopup">Figure 1. Mortality at 30 days</a></p><p id="ch8.appe.fig2"><a href="/books/NBK577869/figure/ch8.appe.fig2/?report=objectonly" target="object" rid-ob="figobch8appefig2" class="figpopup">Figure 2. Mortality at 6 months</a></p><p id="ch8.appe.fig3"><a href="/books/NBK577869/figure/ch8.appe.fig3/?report=objectonly" target="object" rid-ob="figobch8appefig3" class="figpopup">Figure 3. Mortality at 1 year</a></p><p id="ch8.appe.fig4"><a href="/books/NBK577869/figure/ch8.appe.fig4/?report=objectonly" target="object" rid-ob="figobch8appefig4" class="figpopup">Figure 4. Functional outcomes, score of 0-3 on mRS scale at 6 months</a></p><p id="ch8.appe.fig5"><a href="/books/NBK577869/figure/ch8.appe.fig5/?report=objectonly" target="object" rid-ob="figobch8appefig5" class="figpopup">Figure 5. Functional outcomes, score of 0-3 on mRS scale at 1 year</a></p><p id="ch8.appe.fig6"><a href="/books/NBK577869/figure/ch8.appe.fig6/?report=objectonly" target="object" rid-ob="figobch8appefig6" class="figpopup">Figure 6. Quality of life, SF-36 at 1 year (range: 0-100, high is good outcome)</a></p></div><div id="ch8.appe.s2"><h4>E.2. Decompressive hemicraniectomy vs medical treatment in those over 60 years</h4><p id="ch8.appe.fig7"><a href="/books/NBK577869/figure/ch8.appe.fig7/?report=objectonly" target="object" rid-ob="figobch8appefig7" class="figpopup">Figure 7. Mortality, 6 months</a></p><p id="ch8.appe.fig8"><a href="/books/NBK577869/figure/ch8.appe.fig8/?report=objectonly" target="object" rid-ob="figobch8appefig8" class="figpopup">Figure 8. Mortality, 1 year</a></p><p id="ch8.appe.fig9"><a href="/books/NBK577869/figure/ch8.appe.fig9/?report=objectonly" target="object" rid-ob="figobch8appefig9" class="figpopup">Figure 9. Functional outcomes, mRS 0-3 at 6 months</a></p><p id="ch8.appe.fig10"><a href="/books/NBK577869/figure/ch8.appe.fig10/?report=objectonly" target="object" rid-ob="figobch8appefig10" class="figpopup">Figure 10. Functional outcomes, mRS 0-3, 1 year</a></p><p id="ch8.appe.fig11"><a href="/books/NBK577869/figure/ch8.appe.fig11/?report=objectonly" target="object" rid-ob="figobch8appefig11" class="figpopup">Figure 11. Quality of life, EQ-5D, index scale (range: −0.205 “dead” to 1.0 “perfect health”), 1 year</a></p><p id="ch8.appe.fig12"><a href="/books/NBK577869/figure/ch8.appe.fig12/?report=objectonly" target="object" rid-ob="figobch8appefig12" class="figpopup">Figure 12. Quality of Life, EQ-5D, visual analogue scale (range: 0-100, high is good outcome), 1 year</a></p></div><div id="ch8.appe.s3"><h4>E.3. Ordinal shift analysis for decompressive hemicraniectomy vs medical treatment</h4><p id="ch8.appe.fig13"><a href="/books/NBK577869/figure/ch8.appe.fig13/?report=objectonly" target="object" rid-ob="figobch8appefig13" class="figpopup">Figure 13. mRS distribution at 6 months</a></p><p id="ch8.appe.fig14"><a href="/books/NBK577869/figure/ch8.appe.fig14/?report=objectonly" target="object" rid-ob="figobch8appefig14" class="figpopup">Figure 14. mRS distribution at 1 year</a></p></div></div><div id="ch8.appf"><h3>Appendix F. GRADE tables</h3><p id="ch8.appf.tab1"><a href="/books/NBK577869/table/ch8.appf.tab1/?report=objectonly" target="object" rid-ob="figobch8appftab1" class="figpopup">Table 11. Clinical evidence profile: Decompressive hemicraniectomy vs medical treatment for those under 60yrs</a></p><p id="ch8.appf.tab2"><a href="/books/NBK577869/table/ch8.appf.tab2/?report=objectonly" target="object" rid-ob="figobch8appftab2" class="figpopup">Table 12. Clinical evidence profile: Decompressive hemicraniectomy vs medical treatment for those over 60yrs</a></p></div><div id="ch8.appg"><h3>Appendix G. Health economic evidence selection</h3><p id="ch8.appg.fig1"><a href="/books/NBK577869/figure/ch8.appg.fig1/?report=objectonly" target="object" rid-ob="figobch8appgfig1" class="figpopup">Figure 15. Flow chart of health economic study selection for the guideline</a></p></div><div id="ch8.apph"><h3>Appendix H. Excluded studies</h3><div id="ch8.apph.s1"><h4>H.1. Excluded clinical studies</h4><p id="ch8.apph.tab1"><a href="/books/NBK577869/table/ch8.apph.tab1/?report=objectonly" target="object" rid-ob="figobch8apphtab1" class="figpopup">Table 13. Studies excluded from the clinical review</a></p></div></div><div id="ch8.appi"><h3>Appendix I. Health economic evidence tables</h3><p id="ch8.appi.et1"><a href="/books/NBK577869/bin/ch8-appi-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (185K)</span></p></div></div></div><div class="fm-sec"><div><p>FINAL</p></div><div><p>Intervention evidence review</p><p>This evidence review was developed by the National Guideline Centre</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div><div class="small"><span class="label">Bookshelf ID: NBK577869</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/35167208" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">35167208</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobch8tab1"><div id="ch8.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577869/table/ch8.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch8.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_ch8.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_ch8.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People with large volume acute anterior circulation ischaemic stroke with complicating space-occupying brain oedema (sometimes described as malignant middle cerebral artery infarction), evident on cerebral computed tomography or magnetic resonance imaging.</td></tr><tr><th id="hd_b_ch8.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><td headers="hd_b_ch8.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Decompressive surgery plus best medical treatment (ICP monitoring, ventilation, mannitol, other diuretics, corticosteroids, hyperventilation, barbiturates, etc.)</td></tr><tr><th id="hd_b_ch8.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><td headers="hd_b_ch8.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Best medical therapy (ICP monitoring, ventilation, mannitol, other diuretics, corticosteroids, hyperventilation, barbiturates, etc.)</td></tr><tr><th id="hd_b_ch8.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_ch8.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<u>Critical</u>
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</p>
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<p>Mortality 6 months</p>
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<p>Mortality 1 year</p>
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<p>Functional outcome (degree of disability or dependence in daily activities) at 6 months and 1 year:</p>
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<p>Modified Rankin scale (mRS) score of 0-3 or ordinal shift analysis</p>
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<p>
|
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<u>Important</u>
|
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</p>
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<p>Quality of life (both health- and social-related)</p>
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</td></tr><tr><th id="hd_b_ch8.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_ch8.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Randomised controlled trials</p>
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<p>Systematic reviews and meta-analyses of the above</p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch8tab2"><div id="ch8.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of studies included in the evidence review for those aged under 60 years</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577869/table/ch8.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch8.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_ch8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_ch8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Intervention and comparison</th><th id="hd_h_ch8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><th id="hd_h_ch8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th></tr></thead><tbody><tr><td headers="hd_h_ch8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Chua, 2015<a class="bibr" href="#ch8.ref6" rid="ch8.ref6"><sup>6</sup></a></p>
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<p>HeMMi Trial</p>
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</td><td headers="hd_h_ch8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>Decompressive surgery plus medical therapy (n=16)</p>
|
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<p>Vs</p>
|
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<p>Medical therapy (n=13)</p>
|
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</td><td headers="hd_h_ch8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Adults aged 18 to 65 years (mean=50.2 yrs, SD=8.3yrs)</p>
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<p>Philippines</p>
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</td><td headers="hd_h_ch8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l142"><li id="lt454" class="half_rhythm"><div>Mortality at 6 months</div></li><li id="lt455" class="half_rhythm"><div>mRS at 6 months</div></li></ul></td></tr><tr><td headers="hd_h_ch8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Frank, 2014<a class="bibr" href="#ch8.ref12" rid="ch8.ref12"><sup>12</sup></a></p>
|
|
<p>HeADDFIRST trial</p>
|
|
</td><td headers="hd_h_ch8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Decompressive surgery plus medical treatment (n=15)</p>
|
|
<p>Vs</p>
|
|
<p>Medical treatment (n=10)</p>
|
|
</td><td headers="hd_h_ch8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults aged 18 to 75 years (median=55.1 yrs, IQR=45.45 to 62.4yrs)</p>
|
|
<p>United Kingdom</p>
|
|
</td><td headers="hd_h_ch8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l143"><li id="lt456" class="half_rhythm"><div>Mortality at 6 months</div></li><li id="lt457" class="half_rhythm"><div>mRS at 6 months</div></li></ul></td></tr><tr><td headers="hd_h_ch8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Hofmeijer, 2009<a class="bibr" href="#ch8.ref17" rid="ch8.ref17"><sup>17</sup></a></p>
|
|
<p>HAMLET trial</p>
|
|
</td><td headers="hd_h_ch8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Decompressive surgery (n=32)</p>
|
|
<p>Vs</p>
|
|
<p>Medical treatment (n=32)</p>
|
|
</td><td headers="hd_h_ch8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults aged 18 to 60 years (mean=48.7 yrs, SD=9.05yrs)</p>
|
|
<p>Netherlands</p>
|
|
</td><td headers="hd_h_ch8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l144"><li id="lt458" class="half_rhythm"><div>Mortality at 1 year</div></li><li id="lt459" class="half_rhythm"><div>mRS at 1 year</div></li><li id="lt460" class="half_rhythm"><div>Quality of life at 1 year</div></li></ul></td></tr><tr><td headers="hd_h_ch8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Juttler, 2007<a class="bibr" href="#ch8.ref21" rid="ch8.ref21"><sup>21</sup></a></p>
|
|
<p>DESTINY trial</p>
|
|
</td><td headers="hd_h_ch8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Decompressive surgery plus conservative treatment (n=17)</p>
|
|
<p>Vs</p>
|
|
<p>Conservative treatment (n=15)</p>
|
|
</td><td headers="hd_h_ch8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults aged 18 to 60 years (mean=44.6 yrs, SD=9.1yrs)</p>
|
|
<p>Germany</p>
|
|
</td><td headers="hd_h_ch8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l145"><li id="lt461" class="half_rhythm"><div>Mortality at 30 days and 1 year</div></li><li id="lt462" class="half_rhythm"><div>mRS at 6 months and 1 year</div></li></ul></td></tr><tr><td headers="hd_h_ch8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Vahedi, 2007<a class="bibr" href="#ch8.ref46" rid="ch8.ref46"><sup>46</sup></a></p>
|
|
<p>DECIMAL trial</p>
|
|
</td><td headers="hd_h_ch8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Decompressive surgery plus standard medical therapy (n=20)</p>
|
|
<p>Vs</p>
|
|
<p>Standard medical therapy (n=18)</p>
|
|
</td><td headers="hd_h_ch8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults aged 18 to 55 years (mean=43.4 yrs, SD=8.4yrs)</p>
|
|
<p>France</p>
|
|
</td><td headers="hd_h_ch8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l146"><li id="lt463" class="half_rhythm"><div>Mortality at 6 months and 1 year</div></li><li id="lt464" class="half_rhythm"><div>mRS at 6 months and 1 year</div></li></ul></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch8tab3"><div id="ch8.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Summary of studies included in the evidence review for those aged over 60 years</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577869/table/ch8.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch8.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_ch8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_ch8.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Intervention and comparison</th><th id="hd_h_ch8.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><th id="hd_h_ch8.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th></tr></thead><tbody><tr><td headers="hd_h_ch8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Juttler, 2014<a class="bibr" href="#ch8.ref22" rid="ch8.ref22"><sup>22</sup></a></p>
|
|
<p>DESTINY II trial</p>
|
|
</td><td headers="hd_h_ch8.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Decompressive surgery (n=49)</p>
|
|
<p>Vs</p>
|
|
<p>Conservative treatment (n=63)</p>
|
|
</td><td headers="hd_h_ch8.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults aged 61 and above (median=70, range=61 to 82yrs)</p>
|
|
<p>Germany</p>
|
|
</td><td headers="hd_h_ch8.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l147"><li id="lt465" class="half_rhythm"><div>Mortality at 1 year</div></li><li id="lt466" class="half_rhythm"><div>mRS at 6 months and 1 year</div></li><li id="lt467" class="half_rhythm"><div>Quality of life at 1 year</div></li></ul></td></tr><tr><td headers="hd_h_ch8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Slezins, 2012<a class="bibr" href="#ch8.ref40" rid="ch8.ref40"><sup>40</sup></a></td><td headers="hd_h_ch8.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Decompressive surgery plus medical management (n=11)</p>
|
|
<p>Vs</p>
|
|
<p>Medical management (n=13)</p>
|
|
</td><td headers="hd_h_ch8.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults aged 49 to 81 years (mean=61.5 yrs, range=49 to 81yrs)</p>
|
|
<p>Latvia</p>
|
|
</td><td headers="hd_h_ch8.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l148"><li id="lt468" class="half_rhythm"><div>Mortality at 1 year</div></li><li id="lt469" class="half_rhythm"><div>mRS at 6 months and 1 year</div></li></ul></td></tr><tr><td headers="hd_h_ch8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Zhao, 2012<a class="bibr" href="#ch8.ref51" rid="ch8.ref51"><sup>51</sup></a></td><td headers="hd_h_ch8.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Decompressive surgery plus standard medical treatment (n=16)</p>
|
|
<p>Vs</p>
|
|
<p>Standard medical treatment (n=13)</p>
|
|
</td><td headers="hd_h_ch8.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults aged 61 to 80 years (median=69.25 yrs)</p>
|
|
<p>China</p>
|
|
</td><td headers="hd_h_ch8.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l149"><li id="lt470" class="half_rhythm"><div>Mortality at 6 months and 1 year</div></li><li id="lt471" class="half_rhythm"><div>mRS at 6 months and 1 year</div></li></ul></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch8tab4"><div id="ch8.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Clinical evidence summary: Decompressive hemicraniectomy compared to medical treatment for those aged under 60 years</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577869/table/ch8.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch8.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch8.tab4_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_ch8.tab4_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_ch8.tab4_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_ch8.tab4_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_ch8.tab4_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_ch8.tab4_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_ch8.tab4_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch8.tab4_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_ch8.tab4_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_ch8.tab4_1_1_1_5" id="hd_h_ch8.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with Medical Treatment</th><th headers="hd_h_ch8.tab4_1_1_1_5" id="hd_h_ch8.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with DHC (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_ch8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortality at 30 days</td><td headers="hd_h_ch8.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>32</p>
|
|
<p>(1 study)</p>
|
|
<p>30 days</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.22</p>
|
|
<p>(0.06 to 0.88)</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_5 hd_h_ch8.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">533 per 1000</td><td headers="hd_h_ch8.tab4_1_1_1_5 hd_h_ch8.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>416 fewer per 1000</p>
|
|
<p>(from 64 fewer to 501 fewer)</p>
|
|
</td></tr><tr><td headers="hd_h_ch8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortality at 6 months</td><td headers="hd_h_ch8.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>86</p>
|
|
<p>(3 studies)</p>
|
|
<p>6 months</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.52</p>
|
|
<p>(0.32 to 0.86)</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_5 hd_h_ch8.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">545 per 1000</td><td headers="hd_h_ch8.tab4_1_1_1_5 hd_h_ch8.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>262 fewer per 1000</p>
|
|
<p>(from 76 fewer to 371 fewer)</p>
|
|
</td></tr><tr><td headers="hd_h_ch8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortality at 1 year</td><td headers="hd_h_ch8.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>134</p>
|
|
<p>(3 studies)</p>
|
|
<p>1 year</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊕</p>
|
|
<p>HIGH</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.34</p>
|
|
<p>(0.21 to 0.56)</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_5 hd_h_ch8.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">594 per 1000</td><td headers="hd_h_ch8.tab4_1_1_1_5 hd_h_ch8.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>392 fewer per 1000</p>
|
|
<p>(from 261 fewer to 469 fewer)</p>
|
|
</td></tr><tr><td headers="hd_h_ch8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Functional outcomes at 6 months</p>
|
|
<p>Score of 0-3 on mRS scale (range: 0-6, high is poor outcome)</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>118</p>
|
|
<p>(4 studies)</p>
|
|
<p>6 months</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊝⊝⊝</p>
|
|
<p>VERY LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 1.39</p>
|
|
<p>(0.76 to 2.56)</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_5 hd_h_ch8.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">283 per 1000</td><td headers="hd_h_ch8.tab4_1_1_1_5 hd_h_ch8.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>110 more per 1000</p>
|
|
<p>(from 68 fewer to 441 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Functional outcomes at 1 year</p>
|
|
<p>Score of 0-3 on mRS scale (range: 0-6, high is poor outcome)</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>134</p>
|
|
<p>(3 studies)</p>
|
|
<p>1 year</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 1.52</p>
|
|
<p>0.90 to 2.57</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_5 hd_h_ch8.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">250 per 1000</td><td headers="hd_h_ch8.tab4_1_1_1_5 hd_h_ch8.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>130 more per 1000</p>
|
|
<p>(from 25 fewer to 392 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality of life, 1 year, SF-36 mental summary (range: 0-100, high is good outcome)</td><td headers="hd_h_ch8.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>35</p>
|
|
<p>(1 study)</p>
|
|
<p>1 year</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊝⊝⊝</p>
|
|
<p>VERY LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch8.tab4_1_1_1_5 hd_h_ch8.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean SF-36 mental summary in the control groups was</p>
|
|
<p>53</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_5 hd_h_ch8.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean SF-36 mental summary in the intervention groups was</p>
|
|
<p>2 higher</p>
|
|
<p>(5.92 lower to 9.92 higher)</p>
|
|
</td></tr><tr><td headers="hd_h_ch8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality of life, 1 year, SF-36 physical summary (range: 0-100, high is good outcome)</td><td headers="hd_h_ch8.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>35</p>
|
|
<p>(1 study)</p>
|
|
<p>1 year</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;"></td><td headers="hd_h_ch8.tab4_1_1_1_5 hd_h_ch8.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean SF-36 physical summary in the control groups was</p>
|
|
<p>36</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_5 hd_h_ch8.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean SF-36 physical summary in the intervention groups was</p>
|
|
<p>7 lower</p>
|
|
<p>(13.85 to 0.15 lower)</p>
|
|
</td></tr><tr><td headers="hd_h_ch8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality of life, 1 year, VAS (range: 0-100, high is good outcome)</td><td headers="hd_h_ch8.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>32</p>
|
|
<p>(1 study)</p>
|
|
<p>1 year</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch8.tab4_1_1_1_5 hd_h_ch8.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean VAS in the control groups was</p>
|
|
<p>62</p>
|
|
</td><td headers="hd_h_ch8.tab4_1_1_1_5 hd_h_ch8.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean VAS in the intervention groups was</p>
|
|
<p>7 lower</p>
|
|
<p>(27.49 lower to 13.49 higher)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="ch8.tab4_1"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs.</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="ch8.tab4_2"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch8tab5"><div id="ch8.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Clinical evidence summary: Decompressive hemicraniectomy compared to medical treatment for those over 60 years</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577869/table/ch8.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch8.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch8.tab5_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_ch8.tab5_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_ch8.tab5_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_ch8.tab5_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_ch8.tab5_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_ch8.tab5_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_ch8.tab5_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch8.tab5_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_ch8.tab5_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_ch8.tab5_1_1_1_5" id="hd_h_ch8.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with Medical Treatment</th><th headers="hd_h_ch8.tab5_1_1_1_5" id="hd_h_ch8.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Decompressive Hemicraniectomy (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_ch8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortality, 6 months</td><td headers="hd_h_ch8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>29</p>
|
|
<p>(1 study)</p>
|
|
<p>6 months</p>
|
|
</td><td headers="hd_h_ch8.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_ch8.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.20</p>
|
|
<p>(0.05 to 0.8)</p>
|
|
</td><td headers="hd_h_ch8.tab5_1_1_1_5 hd_h_ch8.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">609 per 1000</td><td headers="hd_h_ch8.tab5_1_1_1_5 hd_h_ch8.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>487 fewer per 1000</p>
|
|
<p>(from 122 fewer to 579 fewer)</p>
|
|
</td></tr><tr><td headers="hd_h_ch8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortality, 1 year</td><td headers="hd_h_ch8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>162</p>
|
|
<p>(3 studies)</p>
|
|
<p>1 years</p>
|
|
</td><td headers="hd_h_ch8.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>2</sup></p>
|
|
<p>due to indirectness</p>
|
|
</td><td headers="hd_h_ch8.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.52</p>
|
|
<p>(0.39 to 0.7)</p>
|
|
</td><td headers="hd_h_ch8.tab5_1_1_1_5 hd_h_ch8.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">758 per 1000</td><td headers="hd_h_ch8.tab5_1_1_1_5 hd_h_ch8.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>364 fewer per 1000</p>
|
|
<p>(from 227 fewer to 462 fewer)</p>
|
|
</td></tr><tr><td headers="hd_h_ch8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Functional outcomes, 6 months</p>
|
|
<p>Score of 0-3 on mRS scale (range: 0-6, high is poor outcome)</p>
|
|
</td><td headers="hd_h_ch8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>141</p>
|
|
<p>(2 studies)</p>
|
|
<p>6 months</p>
|
|
</td><td headers="hd_h_ch8.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊝⊝⊝</p>
|
|
<p>VERY LOW<sup>1</sup><sup>,</sup><sup>3</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_ch8.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 2.45</p>
|
|
<p>(0.55 to 10.91)</p>
|
|
</td><td headers="hd_h_ch8.tab5_1_1_1_5 hd_h_ch8.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16 per 1000</td><td headers="hd_h_ch8.tab5_1_1_1_5 hd_h_ch8.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>23 more per 1000</p>
|
|
<p>(from 7 fewer to 159 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Functional outcomes, 1 year</p>
|
|
<p>Score of 0-3 on mRS scale (range: 0-6, high is poor outcome)</p>
|
|
</td><td headers="hd_h_ch8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>165</p>
|
|
<p>(3 studies)</p>
|
|
<p>1 year</p>
|
|
</td><td headers="hd_h_ch8.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊝⊝⊝</p>
|
|
<p>VERY LOW<sup>1</sup><sup>,</sup><sup>3</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_ch8.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 3.18</p>
|
|
<p>(1.03 to 9.83)</p>
|
|
</td><td headers="hd_h_ch8.tab5_1_1_1_5 hd_h_ch8.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34 per 1000</td><td headers="hd_h_ch8.tab5_1_1_1_5 hd_h_ch8.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>100 more per 1000</p>
|
|
<p>(from 10 more to 180 more)<sup>4</sup></p>
|
|
</td></tr><tr><td headers="hd_h_ch8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Quality of life, 1 year</p>
|
|
<p>EQ-5D scale (range: −0.205 “dead” to 1.0 “perfect health”)</p>
|
|
</td><td headers="hd_h_ch8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>100</p>
|
|
<p>(1 study)</p>
|
|
<p>1 years</p>
|
|
</td><td headers="hd_h_ch8.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>3</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_ch8.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch8.tab5_1_1_1_5 hd_h_ch8.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean quality of life, EQ-5D in the control groups was</p>
|
|
<p>−0.1</p>
|
|
</td><td headers="hd_h_ch8.tab5_1_1_1_5 hd_h_ch8.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The EQ-5D in the intervention groups was</p>
|
|
<p>0.10 higher</p>
|
|
<p>(0 to 0.2 higher)</p>
|
|
</td></tr><tr><td headers="hd_h_ch8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Quality of life, 1 year</p>
|
|
<p>EQ-5D, visual analogue scale (range 0-100; high is good outcome)</p>
|
|
</td><td headers="hd_h_ch8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>99</p>
|
|
<p>(1 study)</p>
|
|
<p>1 years</p>
|
|
</td><td headers="hd_h_ch8.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>3</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_ch8.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch8.tab5_1_1_1_5 hd_h_ch8.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean EQ-5D VAS in the control groups was</p>
|
|
<p>7.6</p>
|
|
</td><td headers="hd_h_ch8.tab5_1_1_1_5 hd_h_ch8.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean EQ-5D VAS in the intervention groups was</p>
|
|
<p>16.40 higher</p>
|
|
<p>(6.54 to 26.26 higher)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="ch8.tab5_1"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs.</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="ch8.tab5_2"><p class="no_margin">Downgraded by 1 or 2 increments because the majority of the evidence included an indirect or very indirect population respectively.</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="ch8.tab5_3"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias.</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="ch8.tab5_4"><p class="no_margin">Calculated from risk difference.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch8tab6"><div id="ch8.tab6" class="table"><h3><span class="label">Table 6</span><span class="title">Health economic evidence profile: surgical decompression versus best medical treatment</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577869/table/ch8.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch8.tab6_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch8.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_ch8.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Applicability</th><th id="hd_h_ch8.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Limitations</th><th id="hd_h_ch8.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Other comments</th><th id="hd_h_ch8.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Incremental cost</th><th id="hd_h_ch8.tab6_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Incremental effects</th><th id="hd_h_ch8.tab6_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Cost effectiveness</th><th id="hd_h_ch8.tab6_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Uncertainty</th></tr></thead><tbody><tr><td headers="hd_h_ch8.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hofmeijer, 2013<a class="bibr" href="#ch8.ref18" rid="ch8.ref18"><sup>18</sup></a> (The Netherlands, health system perspective)</td><td headers="hd_h_ch8.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Partially applicable<sup>(a)</sup></td><td headers="hd_h_ch8.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Potentially serious limitations<sup>(b)</sup></td><td headers="hd_h_ch8.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Within-trial analysis (RCT) with Markov model posttrial extrapolation.</p>
|
|
<p>HAMLET RCT included in clinical review<a class="bibr" href="#ch8.ref14" rid="ch8.ref14"><sup>14</sup></a>. Markov model simulating a lifetime time horizon.</p>
|
|
</td><td headers="hd_h_ch8.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£206,742<sup>(c)</sup></td><td headers="hd_h_ch8.tab6_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.2 QALYs</td><td headers="hd_h_ch8.tab6_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ICER: £49,224 per QALY gained (da)</td><td headers="hd_h_ch8.tab6_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NR</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Abbreviations: da: deterministic analysis; ICER: incremental cost-effectiveness ratio; NR: not reported; QALY: quality-adjusted life years; RCT: randomised controlled trial</p></div></dd></dl><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="ch8.tab6_1"><p class="no_margin">Within-trial analysis with post-trial extrapolation, from Dutch societal perspective</p></div></dd></dl><dl class="bkr_refwrap"><dt>(b)</dt><dd><div id="ch8.tab6_2"><p class="no_margin">Treatment effects derived from HAMLET trial only, which reported less favourable outcomes for decompressive surgery compared with other trials. Discounting of costs and outcomes not reported for post-trial Markov model, sensitivity analysis not undertaken for lifetime horizon. Outpatient department and general practitioner resource use obtained retrospectively. Recurrent stroke not modelled. Cycle lengths of Markov model not reported.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(c)</dt><dd><div id="ch8.tab6_3"><p class="no_margin">Converted using 2009 purchasing power parities<a class="bibr" href="#ch8.ref35" rid="ch8.ref35"><sup>35</sup></a></p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch8tab7"><div id="ch8.tab7" class="table"><h3><span class="label">Table 7</span><span class="title">UK costs of non-elective long stay decompressive hemicraniectomy</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577869/table/ch8.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch8.tab7_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Currency Description</th><th id="hd_h_ch8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Unit Cost</th><th id="hd_h_ch8.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Average length of stay</th></tr></thead><tbody><tr><td headers="hd_h_ch8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">AA52D – AA52A Very Major Intracerebral Procedures, 19 years and over, inclusive of excess bed days, with CC Score 0-3 to CC Score 12+; as recorded for Non-Elective Long Stay</td><td headers="hd_h_ch8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£9,174 - £15,386</td><td headers="hd_h_ch8.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.54 – 22.60 days</td></tr><tr><td headers="hd_h_ch8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">AA52B Very Major Intracerebral Procedures, 19 years and over, weighted for complications and co-morbidities for HRG codes: AA52A, AA52B, AA52C and AA52D; as recorded for Non-Elective Long Stay</td><td headers="hd_h_ch8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£10,721</td><td headers="hd_h_ch8.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.17 days</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source: NHS Reference Costs, 2016-2017</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch8appatab1"><div id="ch8.appa.tab1" class="table"><h3><span class="label">Table 7</span><span class="title">Review protocol: Decompressive hemicraniectomy</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577869/table/ch8.appa.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch8.appa.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Field</th><th id="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Content</th></tr></thead><tbody><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review question</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Which patients should be referred for decompressive hemicraniectomy?</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Type of review question</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Intervention</p>
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<p>A review of health economic evidence related to the same review question was conducted in parallel with this review. For details see the health economic review protocol for this NICE guideline.</p>
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</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Objective of the review</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">To examine the effects of decompressive surgery in people with acute ischaemic stroke with cerebral oedema, and to determine if decompressive surgery is effective in improving survival or reducing the risk of disability.</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – population / disease / condition / issue / domain</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People aged over 16 with large volume acute anterior circulation ischaemic stroke with or without complicating space-occupying brain oedema (sometimes described as malignant middle cerebral artery infarction), evident on cerebral computed tomography or magnetic resonance imaging</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – intervention(s) / exposure(s) / prognostic factor(s)</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Decompressive surgery plus medical treatment (mannitol, other diuretics, corticosteroids, hyperventilation, barbiturates, etc)</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – comparator(s) / control or reference (gold) standard</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medical treatment alone</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes and prioritisation</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<u>Critical</u>
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</p>
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<p>Mortality 90 days</p>
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<p>Mortality 1 year</p>
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<p>Functional outcome (degree of disability or dependence in daily activities) at 90 days and 1 year:
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<ul id="l153"><li id="lt477" class="half_rhythm"><div>Modified Rankin Score (mRS) of 3 and 4 – 5</div></li></ul>
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<u>Important</u></p>
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<p>Quality of life (both health- and social-related)</p>
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</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – study design</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Randomised controlled intervention trials</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other inclusion exclusion criteria</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Inclusion</p>
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<p>Language: Restrict to English only</p>
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<p>Setting: Emergency department, High dependency or intensive care units, Hyperacute or acute stroke units, Other hospital settings</p>
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</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Proposed sensitivity / subgroup analysis, or meta-regression</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<u>Strata</u>
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</p>
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<p>Age older than 60 years</p>
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<p>
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<u>Subgroups</u>
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</p>
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<p>Surgery within 24h, 48h, 72h of stroke onset</p>
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<p>Dominant/non-dominant hemisphere</p>
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</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Selection process – duplicate screening / selection / analysis</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Studies are sifted by title and abstract. Potentially significant publications obtained in full text are then assessed against the inclusion criteria specified in this protocol.</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data management (software)</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l154"><li id="lt478" class="half_rhythm"><div>EndNote will be used for reference management, sifting, citations and bibliographies.</div></li><li id="lt479" class="half_rhythm"><div>EviBASE will be used for data extraction and quality assessment for clinical studies.</div></li><li id="lt480" class="half_rhythm"><div>Pairwise meta-analyses will be performed using Cochrane Review Manager (RevMan5).</div></li><li id="lt481" class="half_rhythm"><div>GRADEpro will be used to assess the quality of evidence for each outcome.</div></li></ul></td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Information sources – databases and dates</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Databases: Medline, Embase, Cochrane Library</p>
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<p>Language: Restrict to English only</p>
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<p>Date restriction: 2007</p>
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<p>Key papers
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<ol id="l155"><li id="lt482" class="half_rhythm"><div>Gupta R, Connolly ES, Mayer S et al. Hemicraniectomy for massive middle cerebral artery territory infarction: a systematic review. Stroke 2004;35(2):539–543.</div></li><li id="lt483" class="half_rhythm"><div>Vahedi K, Hofmeijer J, Juettler E et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurology 2007;6(3): 215–222.</div></li><li id="lt484" class="half_rhythm"><div>Hofmeijer J, Kappelle LJ, Algra A et al. (2009) Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Lifethreatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurology 8:326-333.</div></li><li id="lt485" class="half_rhythm"><div>Juttler E, Schwab S, Schmiedek P et al. (2007) Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY): a randomized, controlled trial. Stroke 38:2518-2525.</div></li><li id="lt486" class="half_rhythm"><div>Cruz-Flores S, Berge E, and Whittle IR. (2012) Surgical decompression for cerebral oedema in acute ischaemic stroke. [Review][Update of Cochrane Database Syst Rev. 2002;(3):CD003435; PMID: 12137695]. Cochrane Database of Systematic Reviews 1:CD003435.</div></li></ol></p>
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</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Identify if an update</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Yes 2 papers included in CG68, date cut off 2007</p>
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<p>Question in CG68: Which patients should be referred for decompressive hemicraniectomy?</p>
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<p>Recommendations from CG68</p>
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<p>1.9.2.1 People with middle cerebral artery infarction who meet all of the criteria below should be considered for decompressive hemicraniectomy. They should be referred within 24 hours of onset of symptoms and treated within a maximum of 48 hours.
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<ul id="l156"><li id="lt487" class="half_rhythm"><div>Aged 60 years or under.</div></li><li id="lt488" class="half_rhythm"><div>Clinical deficits suggestive of infarction in the territory of the middle cerebral artery, with a score on the National Institutes of Health Stroke Scale (NIHSS) of above 15.</div></li><li id="lt489" class="half_rhythm"><div>Decrease in the level of consciousness to give a score of 1 or more on item 1a of the NIHSS.</div></li><li id="lt490" class="half_rhythm"><div>Signs on CT of an infarct of at least 50% of the middle cerebral artery territory, with or without additional infarction in the territory of the anterior or posterior cerebral artery on the same side, or infarct volume greater than 145 cm3 as shown on diffusion weighted MRI.</div></li></ul>
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1.9.2.2 People who are referred for decompressive hemicraniectomy should be monitored by appropriately trained professionals skilled in neurological</p>
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</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Author contacts</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://www.nice.org.uk/guidance/indevelopment/gid-ng10071" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.nice.org<wbr style="display:inline-block"></wbr>​.uk/guidance/indevelopment/gid-ng10071</a>
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</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Highlight if amendment to previous protocol</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see section 4.5 of <a href="https://www.nice.org.uk/article/pmg20/chapter/4-Developing-review-questions-and-planning-the-evidence-review#planning-the-evidence-review" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search strategy – for one database</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see <a href="#ch8.appb">appendix B</a></td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data collection process – forms / duplicate</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A standardised evidence table format will be used, and published as <a href="#ch8.appd">appendix D</a> of the evidence report.</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data items – define all variables to be collected</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see evidence tables in <a href="#ch8.appd">Appendix D</a> (clinical evidence tables) or <a href="#ch8.apph">H</a> (health economic evidence tables).</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methods for assessing bias at outcome / study level</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Standard study checklists were used to critically appraise individual studies. For details please see section 6.2 of <a href="https://www.nice.org.uk/article/pmg20/chapter/6-Reviewing-research-evidence#assessing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a></p>
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<p>The risk of bias across all available evidence was evaluated for each outcome using an adaptation of the ‘Grading of Recommendations Assessment, Development and Evaluation (GRADE) toolbox’ developed by the international GRADE working group <a href="http://www.gradeworkinggroup.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.gradeworkinggroup.org/</a></p>
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</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Criteria for quantitative synthesis</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see section 6.4 of <a href="https://www.nice.org.uk/article/pmg20/chapter/6-Reviewing-research-evidence#assessing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methods for quantitative analysis – combining studies and exploring (in)consistency</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see the separate Methods report for this guideline.</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-bias assessment – publication bias, selective reporting bias</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see section 6.2 of <a href="https://www.nice.org.uk/article/pmg20/chapter/6-Reviewing-research-evidence#assessing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Confidence in cumulative evidence</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see sections 6.4 and 9.1 of <a href="https://www.nice.org.uk/article/pmg20/chapter/1-Introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rationale / context – what is known</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see the introduction to the evidence review.</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Describe contributions of authors and guarantor</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>A <a href="https://www.nice.org.uk/guidance/indevelopment/gid-ng10071/documents" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">multidisciplinary committee</a> developed the evidence review. The committee was convened by the National Guideline Centre (NGC) and chaired by Jason Kendall in line with section 3 of <a href="https://www.nice.org.uk/article/pmg20/chapter/1%20Introduction%20and%20overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</p>
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<p>Staff from NGC undertook systematic literature searches, appraised the evidence, conducted meta-analysis and cost-effectiveness analysis where appropriate, and drafted the evidence review in collaboration with the committee. For details please see <a href="https://www.nice.org.uk/article/pmg20/chapter/1-Introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</p>
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</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sources of funding / support</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NGC is funded by NICE and hosted by the Royal College of Physicians.</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Name of sponsor</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NGC is funded by NICE and hosted by the Royal College of Physicians.</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Roles of sponsor</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NICE funds NGC to develop guidelines for those working in the NHS, public health and social care in England.</td></tr><tr><td headers="hd_h_ch8.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PROSPERO registration number</td><td headers="hd_h_ch8.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not registered</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch8appatab2"><div id="ch8.appa.tab2" class="table"><h3><span class="label">Table 8</span><span class="title">Health economic review protocol</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577869/table/ch8.appa.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch8.appa.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_ch8.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Review question</th><th id="hd_h_ch8.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">All questions – health economic evidence</th></tr></thead><tbody><tr><td headers="hd_h_ch8.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Objectives</b>
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</td><td headers="hd_h_ch8.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">To identify health economic studies relevant to any of the review questions.</td></tr><tr><td headers="hd_h_ch8.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Search criteria</b>
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</td><td headers="hd_h_ch8.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l157"><li id="lt491" class="half_rhythm"><div>Populations, interventions and comparators must be as specified in the clinical review protocol above.</div></li><li id="lt492" class="half_rhythm"><div>Studies must be of a relevant health economic study design (cost–utility analysis, cost-effectiveness analysis, cost–benefit analysis, cost–consequences analysis, comparative cost analysis).</div></li><li id="lt493" class="half_rhythm"><div>Studies must not be a letter, editorial or commentary, or a review of health economic evaluations. (Recent reviews will be ordered although not reviewed. The bibliographies will be checked for relevant studies, which will then be ordered.)</div></li><li id="lt494" class="half_rhythm"><div>Unpublished reports will not be considered unless submitted as part of a call for evidence.</div></li><li id="lt495" class="half_rhythm"><div>Studies must be in English.</div></li></ul></td></tr><tr><td headers="hd_h_ch8.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Search strategy</b>
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</td><td headers="hd_h_ch8.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A health economic study search will be undertaken using population-specific terms and a health economic study filter – see <a href="#ch8.appb.s2">appendix B2</a> of reviews. For questions being updated, the search will be run from 2007, which was the cut-off date for the searches conducted for NICE guideline CG68. For the new review question on endovascular therapy, the search will be run from 2007 as studies published before 2007 are not likely to be relevant.</td></tr><tr><td headers="hd_h_ch8.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Review strategy</b>
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</td><td headers="hd_h_ch8.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Studies not meeting any of the search criteria above will be excluded. Studies published before 2002, abstract-only studies and studies from non-OECD countries or the USA will also be excluded.</p>
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<p>Studies published after 2002 that were included in the previous guideline will be reassessed for inclusion and may be included or selectively excluded based on their relevance to the questions covered in this update and whether more applicable evidence is also identified.</p>
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<p>Each remaining study will be assessed for applicability and methodological limitations using the NICE economic evaluation checklist which can be found in <a href="#ch8.apph">appendix H</a> of Developing NICE guidelines: the manual (2014).<a class="bibr" href="#ch8.ref32" rid="ch8.ref32"><sup>32</sup></a></p>
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<p><b>Inclusion and exclusion criteria</b>
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<ul id="l158"><li id="lt496" class="half_rhythm"><div>If a study is rated as both ‘Directly applicable’ and with ‘Minor limitations’ then it will be included in the guideline. A health economic evidence table will be completed and it will be included in the health economic evidence profile.</div></li><li id="lt497" class="half_rhythm"><div>If a study is rated as either ‘Not applicable’ or with ‘Very serious limitations’ then it will usually be excluded from the guideline. If it is excluded then a health economic evidence table will not be completed and it will not be included in the health economic evidence profile.</div></li><li id="lt498" class="half_rhythm"><div>If a study is rated as ‘Partially applicable’, with ‘Potentially serious limitations’ or both then there is discretion over whether it should be included.</div></li></ul>
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<b>Where there is discretion</b></p>
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<p>The health economist will make a decision based on the relative applicability and quality of the available evidence for that question, in discussion with the guideline committee if required. The ultimate aim is to include health economic studies that are helpful for decision-making in the context of the guideline and the current NHS setting. If several studies are considered of sufficiently high applicability and methodological quality that they could all be included, then the health economist, in discussion with the committee if required, may decide to include only the most applicable studies and to selectively exclude the remaining studies. All studies excluded on the basis of applicability or methodological limitations will be listed with explanation as excluded health economic studies in <a href="#ch8.apph">appendix H</a>.</p>
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<p>The health economist will be guided by the following hierarchies.</p>
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<p><i>Setting:</i>
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<ul id="l159"><li id="lt499" class="half_rhythm"><div>UK NHS (most applicable).</div></li><li id="lt500" class="half_rhythm"><div>OECD countries with predominantly public health insurance systems (for example, France, Germany, Sweden).</div></li><li id="lt501" class="half_rhythm"><div>OECD countries with predominantly private health insurance systems (for example, Switzerland).</div></li><li id="lt502" class="half_rhythm"><div>Studies set in non-OECD countries or in the USA will be excluded before being assessed for applicability and methodological limitations.</div></li></ul>
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<i>Health economic study type:</i>
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<ul id="l160"><li id="lt503" class="half_rhythm"><div>Cost–utility analysis (most applicable).</div></li><li id="lt504" class="half_rhythm"><div>Other type of full economic evaluation (cost–benefit analysis, cost-effectiveness analysis, cost–consequences analysis).</div></li><li id="lt505" class="half_rhythm"><div>Comparative cost analysis.</div></li><li id="lt506" class="half_rhythm"><div>Non-comparative cost analyses including cost-of-illness studies will be excluded before being assessed for applicability and methodological limitations.</div></li></ul>
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<i>Year of analysis:</i>
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<ul id="l161"><li id="lt507" class="half_rhythm"><div>The more recent the study, the more applicable it will be.</div></li><li id="lt508" class="half_rhythm"><div>Studies published in 2002 or later (including any such studies included in the previous guideline) but that depend on unit costs and resource data entirely or predominantly from before 2002 will be rated as ‘Not applicable’.</div></li><li id="lt509" class="half_rhythm"><div>Studies published before 2002 (including any such studies included in the previous guideline) will be excluded before being assessed for applicability and methodological limitations.</div></li></ul>
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<i>Quality and relevance of effectiveness data used in the health economic analysis:</i>
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<ul id="l162"><li id="lt510" class="half_rhythm"><div>The more closely the clinical effectiveness data used in the health economic analysis match with the outcomes of the studies included in the clinical review the more useful the analysis will be for decision-making in the guideline.</div></li></ul></p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch8appbtab1"><div id="ch8.appb.tab1" class="table"><h3><span class="label">Table 9</span><span class="title">Database date parameters and filters used</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577869/table/ch8.appb.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch8.appb.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch8.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Database</th><th id="hd_h_ch8.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dates searched</th><th id="hd_h_ch8.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_ch8.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline (OVID)</td><td headers="hd_h_ch8.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">01 January 2018 – 22 June 2018</td><td headers="hd_h_ch8.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Exclusions</p>
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<p>Randomised controlled trials</p>
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<p>Systematic review studies</p>
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</td></tr><tr><td headers="hd_h_ch8.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase (OVID)</td><td headers="hd_h_ch8.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">01 January 2018 – 22 June 2018</td><td headers="hd_h_ch8.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Exclusions</p>
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<p>Randomised controlled trials</p>
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<p>Systematic review studies</p>
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</td></tr><tr><td headers="hd_h_ch8.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The Cochrane Library (Wiley)</td><td headers="hd_h_ch8.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Cochrane Reviews to 2018 Issue 6 of 12</p>
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<p>CENTRAL to 2018 Issue 5 of 12</p>
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<p>DARE, and NHSEED to 2015 Issue 2 of 4</p>
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<p>HTA to 2016 Issue 4 of 4</p>
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</td><td headers="hd_h_ch8.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch8appbtab2"><div id="ch8.appb.tab2" class="table"><h3><span class="title">Medline (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577869/table/ch8.appb.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch8.appb.tab2_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Stroke/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(stroke or strokes).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((cerebro* or cerebral*) adj2 (accident* or apoplexy)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(CVA or poststoke*1).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Intracranial Hemorrhages/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(brain adj2 (attack*1 or hemorrhag* or haemorrhag* or bleed* or infarct*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((intracerebral or intracranial or cerebral* or cerebro* or cerebrum or cerebellum or subarachnoid* or choroidal or basal ganglia or subdural) adj3 (hemorrhag* or haemorrhag* or bleed*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Brain infarction/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Carotid Artery Thrombosis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or crescendo or transient or lacunar) adj3 (infarct* or thrombo* or emboli* or occlus* or hypoxi*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Brain Ischemia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or crescendo or transient or lacunar) adj3 isch?emi*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ischemic Attack, Transient/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(isch?emi* adj2 attack*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">TIA.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or crescendo or transient or lacunar) adj3 (oedema* or edema* or swell* or swollen or enlarg*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-16</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">news/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp historical article/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">comment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/18-25</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26 not 27</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animals, Laboratory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experimentation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Models, Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/28-34</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17 not 35</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">decompression, surgical/ or neurosurgical procedures/ or craniotomy/ or trephining/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(decompress* or craniectom* or craniotom* or hemi-craniect* or hemicraniect* or trepa* or treph*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(hippocampectom* or lobectom* or strokectom*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37 or 38 or 39</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36 and 40</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">controlled clinical trial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomi#ed.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo.ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomly.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Clinical Trials as topic.sh.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">trial.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/42-48</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-Analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Meta-Analysis as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(meta analy* or metanaly* or metaanaly* or meta regression).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((systematic* or evidence*) adj3 (review* or overview*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(reference list* or bibliograph* or hand search* or manual search* or relevant journals).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search strategy or search criteria or systematic search or study selection or data extraction).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search* adj4 literature).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(medline or pubmed or cochrane or embase or psychlit or psyclit or psychinfo or psycinfo or cinahl or science citation index or bids or cancerlit).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cochrane.jw.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((multiple treatment* or indirect or mixed) adj2 comparison*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/50-59</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49 or 60</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">62.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41 and 61</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">63.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 62 to English language</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch8appbtab3"><div id="ch8.appb.tab3" class="table"><h3><span class="title">Embase (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577869/table/ch8.appb.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch8.appb.tab3_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*cerebrovascular accident/ or cardioembolic stroke/ or exp experimental stroke/ or lacunar stroke/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(stroke or strokes).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((cerebro* or cerebral*) adj2 (accident* or apoplexy)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(CVA or poststroke or poststrokes).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*brain hemorrhage/ or *brain ventricle hemorrhage/ or *cerebellum hemorrhage/ or *subarachnoid hemorrhage/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(brain adj2 (attack*1 or hemorrhag* or haemorrhag* or bleed* or infarct*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((intracerebral or intracranial or cerebral* or cerebro* or cerebrum or cerebellum or subarachnoid* or choroidal or basal ganglia or subdural) adj3 (hemorrhag* or haemorrhag* or bleed*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*brain infarction/ or *brain infarction size/ or *brain stem infarction/ or *cerebellum infarction/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*Carotid Artery Thrombosis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or transient or lacunar) adj3 (infarct* or thrombo* or emboli* or occlus* or hypoxi*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*brain ischemia/ or *hypoxic ischemic encephalopathy/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or crescendo or transient or lacunar) adj3 isch?emi*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*Transient ischemic attack/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(isch?emi* adj2 attack*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">TIA.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or crescendo or transient or lacunar) adj3 (oedema* or edema* or swell* or swollen or enlarg*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-16</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/ or case study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/18-22</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23 not 24</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonhuman/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/25-32</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17 not 33</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 34 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">braint decompression/ or decompression surgery/ or decompression/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">skull surgery/ or craniectomy/ or cranioplasty/ or craniotomy/ or neurosurgery/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(decompress* or craniectom* or craniotom* or hemi-craniect* or hemicraniect* or trepa* or treph*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(hippocampectom* or lobectom* or strokectom*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/36-39</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35 and 40</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">factorial*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(crossover* or cross over*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((doubl* or singl*) adj blind*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(assign* or allocat* or volunteer* or placebo*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">crossover procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">single blind procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">double blind procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/42-50</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">systematic review/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">meta-analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(meta analy* or metanaly* or metaanaly* or meta regression).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((systematic* or evidence*) adj3 (review* or overview*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(reference list* or bibliograph* or hand search* or manual search* or relevant journals).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search strategy or search criteria or systematic search or study selection or data extraction).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search* adj4 literature).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(medline or pubmed or cochrane or embase or psychlit or psyclit or psychinfo or psycinfo or cinahl or science citation index or bids or cancerlit).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cochrane.jw.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((multiple treatment* or indirect or mixed) adj2 comparison*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">62.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/52-61</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">63.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51 or 62</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch8appbtab4"><div id="ch8.appb.tab4" class="table"><h3><span class="title">Cochrane Library (Wiley) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577869/table/ch8.appb.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch8.appb.tab4_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Stroke] explode all trees</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(stroke or strokes):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((cerebro* or cerebral*) near/2 (accident* or apoplexy)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(CVA or poststroke or poststrokes):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Intracranial Hemorrhages] explode all trees</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(brain near/2 (attack*1 or hemorrhag* or haemorrhag* or bleed* or infarct*)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((intracerebral or intracranial or cerebral* or cerebro* or cerebrum or cerebellum or subarachnoid* or choroidal or basal ganglia or subdural) near/3 (hemorrhag* or haemorrhag* or bleed*)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Brain Infarction] explode all trees</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Carotid Artery Thrombosis] explode all trees</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or transient or lacunar) near/3 (infarct* or thrombo* or emboli* or occlus* or hypoxi*)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Brain Ischemia] explode all trees</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or crescendo or transient or lacunar) near/3 isch?emi*):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Ischemic Attack, Transient] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(isch?emi* near/2 attack*):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or crescendo or transient or lacunar) near/3 (oedema* or edema* or swell* or swollen or enlarg*)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">TIA:ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(or #1-#16)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Decompression, Surgical] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Neurosurgical Procedures] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Craniotomy] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Trephining] explode all trees</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(decompress* or craniectom* or craniotom* or hemi-craniect* or hemicraniect* or trepa* or treph*):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(hippocampectom* or lobectom* or strokectom*):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(or #18-#23)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#17 and #24</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch8appbtab5"><div id="ch8.appb.tab5" class="table"><h3><span class="label">Table 10</span><span class="title">Database date parameters and filters used</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577869/table/ch8.appb.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch8.appb.tab5_lrgtbl__"><table><thead><tr><th id="hd_h_ch8.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Database</th><th id="hd_h_ch8.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dates searched</th><th id="hd_h_ch8.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_ch8.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline</td><td headers="hd_h_ch8.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">01 January 2007 – 06 August 2018</td><td headers="hd_h_ch8.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Exclusions</p>
|
|
<p>Health economics studies</p>
|
|
</td></tr><tr><td headers="hd_h_ch8.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase</td><td headers="hd_h_ch8.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">01 January 2007 – 06 August 2018</td><td headers="hd_h_ch8.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Exclusions</p>
|
|
<p>Health economics studies</p>
|
|
</td></tr><tr><td headers="hd_h_ch8.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Centre for Research and Dissemination (CRD)</td><td headers="hd_h_ch8.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HTA - 01 January 2007 – 10 November 2017</p>
|
|
<p>NHSEED - 01 January 2007 – March 2015</p>
|
|
</td><td headers="hd_h_ch8.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch8appbtab6"><div id="ch8.appb.tab6" class="table"><h3><span class="title">Medline (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577869/table/ch8.appb.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch8.appb.tab6_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Stroke/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(stroke or strokes).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((cerebro* or cerebral*) adj2 (accident* or apoplexy)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(CVA or poststroke or poststrokes).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Intracranial Hemorrhages/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(brain adj2 (attack*1 or hemorrhag* or haemorrhag* or bleed* or infarct*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((intracerebral or intracranial or cerebral* or cerebro* or cerebrum or cerebellum or subarachnoid* or choroidal or basal ganglia or subdural) adj3 (hemorrhag* or haemorrhag* or bleed*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Brain infarction/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Carotid Artery Thrombosis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or transient or lacunar) adj3 (infarct* or thrombo* or emboli* or occlus* or hypoxi*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Brain Ischemia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or crescendo or transient or lacunar) adj3 isch?emi*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ischemic Attack, Transient/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(isch?emi* adj2 attack*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">TIA.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-15</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">news/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp historical article/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">comment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/17-24</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25 not 26</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animals, Laboratory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experimentation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Models, Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/27-33</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16 not 34</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 35 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(exp child/ or exp pediatrics/ or exp infant/) not (exp adolescent/ or exp adult/ or exp middle age/ or exp aged/)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36 not 37</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">economics/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">value of life/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “costs and cost analysis”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics, Hospital/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics, medical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics, nursing/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">economics, pharmaceutical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Fees and Charges”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp budgets/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or pharmaco?economic*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or pricing*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effectiv* or utilit* or benefit* or minimi* or unit* or estimat* or variable*)).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(financ* or fee or fees).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or monetary)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/39-54</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38 and 55</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch8appbtab7"><div id="ch8.appb.tab7" class="table"><h3><span class="title">Embase (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577869/table/ch8.appb.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch8.appb.tab7_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*cerebrovascular accident/ or cardioembolic stroke/ or exp experimental stroke/ or lacunar stroke/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(stroke or strokes).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((cerebro* or cerebral*) adj2 (accident* or apoplexy)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(CVA or poststroke or poststrokes).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*brain hemorrhage/ or *brain ventricle hemorrhage/ or *cerebellum hemorrhage/ or *subarachnoid hemorrhage/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(brain adj2 (attack*1 or hemorrhag* or haemorrhag* or bleed* or infarct*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((intracerebral or intracranial or cerebral* or cerebro* or cerebrum or cerebellum or subarachnoid* or choroidal or basal ganglia or subdural) adj3 (hemorrhag* or haemorrhag* or bleed*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*brain infarction/ or *brain infarction size/ or *brain stem infarction/ or *cerebellum infarction/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*Carotid Artery Thrombosis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or transient or lacunar) adj3 (infarct* or thrombo* or emboli* or occlus* or hypoxi*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*brain ischemia/ or *hypoxic ischemic encephalopathy/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or crescendo or transient or lacunar) adj3 isch?emi*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*Transient ischemic attack/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(isch?emi* adj2 attack*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">TIA.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-15</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/ or case study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/17-21</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22 not 23</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonhuman/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/24-31</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16 not 32</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(exp child/ or exp pediatrics/) not (exp adult/ or exp adolescent/)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33 not 34</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">health economics/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp economic evaluation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp health care cost/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp fee/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">funding/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or pharmaco?economic*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or pricing*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effectiv* or utilit* or benefit* or minimi* or unit* or estimat* or variable*)).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(finance* or fee or fees).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or monetary)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/36-48</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35 and 49</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch8appbtab8"><div id="ch8.appb.tab8" class="table"><h3><span class="title">NHS EED and HTA (CRD) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577869/table/ch8.appb.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch8.appb.tab8_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Stroke EXPLODE 1 2</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((stroke or strokes))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(((cerebro* or cerebral*) adj2 (accident* or apoplexy)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((CVA or poststroke or poststrokes))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Intracranial Hemorrhages EXPLODE ALL TREES</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain adj2 (attack*1 or hemorrhag* or haemorrhag* or bleed* or infarct*)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(((intracerebral or intracranial or cerebral* or cerebro* or cerebrum or cerebellum or subarachnoid* or choroidal or basal ganglia or subdural) adj3 (hemorrhag* or haemorrhag* or bleed*)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Brain Infarction EXPLODE ALL TREES</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Carotid Artery Thrombosis EXPLODE ALL TREES</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or transient or lacunar) adj3 (infarct* or thrombo* or emboli* or occlus* or hypoxi*)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Brain Ischemia EXPLODE ALL TREES</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or crescendo or transient or lacunar) adj3 isch?emi*))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Ischemic Attack, Transient EXPLODE ALL TREES</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((isch?emi* adj2 attack*))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14</td></tr></tbody></table></div></div></article><article data-type="fig" id="figobch8appcfig1"><div id="ch8.appc.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%201.%20Flow%20chart%20of%20clinical%20study%20selection%20for%20the%20review%20of%20decompressive%20hemicraniectomy.&p=BOOKS&id=577869_ch8appcf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577869/bin/ch8appcf1.jpg" alt="Figure 1. Flow chart of clinical study selection for the review of decompressive hemicraniectomy." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 1</span><span class="title">Flow chart of clinical study selection for the review of decompressive hemicraniectomy</span></h3></div></article><article data-type="fig" id="figobch8appefig1"><div id="ch8.appe.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%201.%20Mortality%20at%2030%20days.&p=BOOKS&id=577869_ch8appef1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577869/bin/ch8appef1.jpg" alt="Figure 1. Mortality at 30 days." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 1</span><span class="title">Mortality at 30 days</span></h3></div></article><article data-type="fig" id="figobch8appefig2"><div id="ch8.appe.fig2" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%202.%20Mortality%20at%206%20months.&p=BOOKS&id=577869_ch8appef2.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577869/bin/ch8appef2.jpg" alt="Figure 2. Mortality at 6 months." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 2</span><span class="title">Mortality at 6 months</span></h3></div></article><article data-type="fig" id="figobch8appefig3"><div id="ch8.appe.fig3" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%203.%20Mortality%20at%201%20year.&p=BOOKS&id=577869_ch8appef3.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577869/bin/ch8appef3.jpg" alt="Figure 3. Mortality at 1 year." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 3</span><span class="title">Mortality at 1 year</span></h3></div></article><article data-type="fig" id="figobch8appefig4"><div id="ch8.appe.fig4" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%204.%20Functional%20outcomes%2C%20score%20of%200-3%20on%20mRS%20scale%20at%206%20months.&p=BOOKS&id=577869_ch8appef4.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577869/bin/ch8appef4.jpg" alt="Figure 4. Functional outcomes, score of 0-3 on mRS scale at 6 months." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 4</span><span class="title">Functional outcomes, score of 0-3 on mRS scale at 6 months</span></h3></div></article><article data-type="fig" id="figobch8appefig5"><div id="ch8.appe.fig5" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%205.%20Functional%20outcomes%2C%20score%20of%200-3%20on%20mRS%20scale%20at%201%20year.&p=BOOKS&id=577869_ch8appef5.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577869/bin/ch8appef5.jpg" alt="Figure 5. Functional outcomes, score of 0-3 on mRS scale at 1 year." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 5</span><span class="title">Functional outcomes, score of 0-3 on mRS scale at 1 year</span></h3></div></article><article data-type="fig" id="figobch8appefig6"><div id="ch8.appe.fig6" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%206.%20Quality%20of%20life%2C%20SF-36%20at%201%20year%20(range%3A%200-100%2C%20high%20is%20good%20outcome).&p=BOOKS&id=577869_ch8appef6.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577869/bin/ch8appef6.jpg" alt="Figure 6. Quality of life, SF-36 at 1 year (range: 0-100, high is good outcome)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 6</span><span class="title">Quality of life, SF-36 at 1 year (range: 0-100, high is good outcome)</span></h3></div></article><article data-type="fig" id="figobch8appefig7"><div id="ch8.appe.fig7" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%207.%20Mortality%2C%206%20months.&p=BOOKS&id=577869_ch8appef7.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577869/bin/ch8appef7.jpg" alt="Figure 7. Mortality, 6 months." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 7</span><span class="title">Mortality, 6 months</span></h3></div></article><article data-type="fig" id="figobch8appefig8"><div id="ch8.appe.fig8" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%208.%20Mortality%2C%201%20year.&p=BOOKS&id=577869_ch8appef8.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577869/bin/ch8appef8.jpg" alt="Figure 8. Mortality, 1 year." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 8</span><span class="title">Mortality, 1 year</span></h3></div></article><article data-type="fig" id="figobch8appefig9"><div id="ch8.appe.fig9" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%209.%20Functional%20outcomes%2C%20mRS%200-3%20at%206%20months.&p=BOOKS&id=577869_ch8appef9.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577869/bin/ch8appef9.jpg" alt="Figure 9. Functional outcomes, mRS 0-3 at 6 months." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 9</span><span class="title">Functional outcomes, mRS 0-3 at 6 months</span></h3></div></article><article data-type="fig" id="figobch8appefig10"><div id="ch8.appe.fig10" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2010.%20Functional%20outcomes%2C%20mRS%200-3%2C%201%20year.&p=BOOKS&id=577869_ch8appef10.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577869/bin/ch8appef10.jpg" alt="Figure 10. Functional outcomes, mRS 0-3, 1 year." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 10</span><span class="title">Functional outcomes, mRS 0-3, 1 year</span></h3></div></article><article data-type="fig" id="figobch8appefig11"><div id="ch8.appe.fig11" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2011.%20Quality%20of%20life%2C%20EQ-5D%2C%20index%20scale%20(range%3A%20%022120.205%20%0201Cdead%0201D%20to%201.0%20%0201Cperfect%20health%0201D)%2C%201%20year.&p=BOOKS&id=577869_ch8appef11.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577869/bin/ch8appef11.jpg" alt="Figure 11. Quality of life, EQ-5D, index scale (range: −0.205 “dead” to 1.0 “perfect health”), 1 year." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 11</span><span class="title">Quality of life, EQ-5D, index scale (range: −0.205 “dead” to 1.0 “perfect health”), 1 year</span></h3></div></article><article data-type="fig" id="figobch8appefig12"><div id="ch8.appe.fig12" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2012.%20Quality%20of%20Life%2C%20EQ-5D%2C%20visual%20analogue%20scale%20(range%3A%200-100%2C%20high%20is%20good%20outcome)%2C%201%20year.&p=BOOKS&id=577869_ch8appef12.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577869/bin/ch8appef12.jpg" alt="Figure 12. Quality of Life, EQ-5D, visual analogue scale (range: 0-100, high is good outcome), 1 year." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 12</span><span class="title">Quality of Life, EQ-5D, visual analogue scale (range: 0-100, high is good outcome), 1 year</span></h3></div></article><article data-type="fig" id="figobch8appefig13"><div id="ch8.appe.fig13" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2013.%20mRS%20distribution%20at%206%20months.&p=BOOKS&id=577869_ch8appef13.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577869/bin/ch8appef13.jpg" alt="Figure 13. mRS distribution at 6 months." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 13</span><span class="title">mRS distribution at 6 months</span></h3></div></article><article data-type="fig" id="figobch8appefig14"><div id="ch8.appe.fig14" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2014.%20mRS%20distribution%20at%201%20year.&p=BOOKS&id=577869_ch8appef14.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577869/bin/ch8appef14.jpg" alt="Figure 14. mRS distribution at 1 year." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 14</span><span class="title">mRS distribution at 1 year</span></h3></div></article><article data-type="table-wrap" id="figobch8appftab1"><div id="ch8.appf.tab1" class="table"><h3><span class="label">Table 11</span><span class="title">Clinical evidence profile: Decompressive hemicraniectomy vs medical treatment for those under 60yrs</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577869/table/ch8.appf.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch8.appf.tab1_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch8.appf.tab1_1_1_1_1" colspan="7" rowspan="1" style="text-align:center;vertical-align:middle;">Quality assessment</th><th id="hd_h_ch8.appf.tab1_1_1_1_2" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">No of patients</th><th id="hd_h_ch8.appf.tab1_1_1_1_3" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Effect</th><th id="hd_h_ch8.appf.tab1_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch8.appf.tab1_1_1_1_4" style="text-align:center;vertical-align:middle;">Quality</th><th id="hd_h_ch8.appf.tab1_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_ch8.appf.tab1_1_1_1_5" style="text-align:center;vertical-align:middle;">Importance</th></tr><tr><th headers="hd_h_ch8.appf.tab1_1_1_1_1" id="hd_h_ch8.appf.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">No of studies</th><th headers="hd_h_ch8.appf.tab1_1_1_1_1" id="hd_h_ch8.appf.tab1_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Design</th><th headers="hd_h_ch8.appf.tab1_1_1_1_1" id="hd_h_ch8.appf.tab1_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk of bias</th><th headers="hd_h_ch8.appf.tab1_1_1_1_1" id="hd_h_ch8.appf.tab1_1_1_2_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Inconsistency</th><th headers="hd_h_ch8.appf.tab1_1_1_1_1" id="hd_h_ch8.appf.tab1_1_1_2_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Indirectness</th><th headers="hd_h_ch8.appf.tab1_1_1_1_1" id="hd_h_ch8.appf.tab1_1_1_2_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Imprecision</th><th headers="hd_h_ch8.appf.tab1_1_1_1_1" id="hd_h_ch8.appf.tab1_1_1_2_7" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Other considerations</th><th headers="hd_h_ch8.appf.tab1_1_1_1_2" id="hd_h_ch8.appf.tab1_1_1_2_8" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">DHC</th><th headers="hd_h_ch8.appf.tab1_1_1_1_2" id="hd_h_ch8.appf.tab1_1_1_2_9" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Medical Treatment</th><th headers="hd_h_ch8.appf.tab1_1_1_1_3" id="hd_h_ch8.appf.tab1_1_1_2_10" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Relative (95% CI)</th><th headers="hd_h_ch8.appf.tab1_1_1_1_3" id="hd_h_ch8.appf.tab1_1_1_2_11" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Absolute</th></tr></thead><tbody><tr><th headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_1 hd_h_ch8.appf.tab1_1_1_2_2 hd_h_ch8.appf.tab1_1_1_2_3 hd_h_ch8.appf.tab1_1_1_2_4 hd_h_ch8.appf.tab1_1_1_2_5 hd_h_ch8.appf.tab1_1_1_2_6 hd_h_ch8.appf.tab1_1_1_2_7 hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_8 hd_h_ch8.appf.tab1_1_1_2_9 hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_10 hd_h_ch8.appf.tab1_1_1_2_11 hd_h_ch8.appf.tab1_1_1_1_4 hd_h_ch8.appf.tab1_1_1_1_5" id="hd_b_ch8.appf.tab1_1_1_1_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Mortality at 30 days</th></tr><tr><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_1 hd_b_ch8.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_2 hd_b_ch8.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_3 hd_b_ch8.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_4 hd_b_ch8.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_5 hd_b_ch8.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_6 hd_b_ch8.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_7 hd_b_ch8.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_8 hd_b_ch8.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
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<p>2/17</p>
|
|
<p>(11.8%)</p>
|
|
</td><td headers="hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_9 hd_b_ch8.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">53.3%</td><td headers="hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_10 hd_b_ch8.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.22 (0.06 to 0.88)</td><td headers="hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_11 hd_b_ch8.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">416 fewer per 1000 (from 64 fewer to 501 fewer)</td><td headers="hd_h_ch8.appf.tab1_1_1_1_4 hd_b_ch8.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁⨁⨁◯</p>
|
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<p>MODERATE</p>
|
|
</td><td headers="hd_h_ch8.appf.tab1_1_1_1_5 hd_b_ch8.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_1 hd_h_ch8.appf.tab1_1_1_2_2 hd_h_ch8.appf.tab1_1_1_2_3 hd_h_ch8.appf.tab1_1_1_2_4 hd_h_ch8.appf.tab1_1_1_2_5 hd_h_ch8.appf.tab1_1_1_2_6 hd_h_ch8.appf.tab1_1_1_2_7 hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_8 hd_h_ch8.appf.tab1_1_1_2_9 hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_10 hd_h_ch8.appf.tab1_1_1_2_11 hd_h_ch8.appf.tab1_1_1_1_4 hd_h_ch8.appf.tab1_1_1_1_5" id="hd_b_ch8.appf.tab1_1_1_3_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Mortality at 6 months</th></tr><tr><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_1 hd_b_ch8.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_2 hd_b_ch8.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_3 hd_b_ch8.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_4 hd_b_ch8.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_5 hd_b_ch8.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_6 hd_b_ch8.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_7 hd_b_ch8.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_8 hd_b_ch8.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
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<p>15/47</p>
|
|
<p>(31.9%)</p>
|
|
</td><td headers="hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_9 hd_b_ch8.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">54.54%</td><td headers="hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_10 hd_b_ch8.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.52 (0.32 to 0.86)</td><td headers="hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_11 hd_b_ch8.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">262 fewer per 1000 (from 76 fewer to 371 fewer)</td><td headers="hd_h_ch8.appf.tab1_1_1_1_4 hd_b_ch8.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⨁⨁⨁◯</p>
|
|
<p>MODERATE</p>
|
|
</td><td headers="hd_h_ch8.appf.tab1_1_1_1_5 hd_b_ch8.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_1 hd_h_ch8.appf.tab1_1_1_2_2 hd_h_ch8.appf.tab1_1_1_2_3 hd_h_ch8.appf.tab1_1_1_2_4 hd_h_ch8.appf.tab1_1_1_2_5 hd_h_ch8.appf.tab1_1_1_2_6 hd_h_ch8.appf.tab1_1_1_2_7 hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_8 hd_h_ch8.appf.tab1_1_1_2_9 hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_10 hd_h_ch8.appf.tab1_1_1_2_11 hd_h_ch8.appf.tab1_1_1_1_4 hd_h_ch8.appf.tab1_1_1_1_5" id="hd_b_ch8.appf.tab1_1_1_5_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Mortality at 1 year</th></tr><tr><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_1 hd_b_ch8.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_2 hd_b_ch8.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_3 hd_b_ch8.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_4 hd_b_ch8.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_5 hd_b_ch8.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_6 hd_b_ch8.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_7 hd_b_ch8.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_8 hd_b_ch8.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>15/69</p>
|
|
<p>(21.7%)</p>
|
|
</td><td headers="hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_9 hd_b_ch8.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">59.38%</td><td headers="hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_10 hd_b_ch8.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.34 (0.21 to 0.56)</td><td headers="hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_11 hd_b_ch8.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">392 fewer per 1000 (from 261 fewer to 469 fewer)</td><td headers="hd_h_ch8.appf.tab1_1_1_1_4 hd_b_ch8.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⨁⨁⨁⨁</p>
|
|
<p>HIGH</p>
|
|
</td><td headers="hd_h_ch8.appf.tab1_1_1_1_5 hd_b_ch8.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_1 hd_h_ch8.appf.tab1_1_1_2_2 hd_h_ch8.appf.tab1_1_1_2_3 hd_h_ch8.appf.tab1_1_1_2_4 hd_h_ch8.appf.tab1_1_1_2_5 hd_h_ch8.appf.tab1_1_1_2_6 hd_h_ch8.appf.tab1_1_1_2_7 hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_8 hd_h_ch8.appf.tab1_1_1_2_9 hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_10 hd_h_ch8.appf.tab1_1_1_2_11 hd_h_ch8.appf.tab1_1_1_1_4 hd_h_ch8.appf.tab1_1_1_1_5" id="hd_b_ch8.appf.tab1_1_1_7_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Functional outcomes at 6 months, score of 0-3 on mRS scale (range: 0-6, high is poor outcome)</th></tr><tr><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_1 hd_b_ch8.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_2 hd_b_ch8.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_3 hd_b_ch8.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>2</sup></td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_4 hd_b_ch8.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_5 hd_b_ch8.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_6 hd_b_ch8.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>1</sup></td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_7 hd_b_ch8.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_8 hd_b_ch8.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>20/64</p>
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<p>(31.3%)</p>
|
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</td><td headers="hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_9 hd_b_ch8.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">28.3%</td><td headers="hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_10 hd_b_ch8.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.39 (0.76 to 2.56)</td><td headers="hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_11 hd_b_ch8.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">110 more per 1000 (from 68 fewer to 441 more)</td><td headers="hd_h_ch8.appf.tab1_1_1_1_4 hd_b_ch8.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁◯◯◯</p>
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<p>VERY LOW</p>
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|
</td><td headers="hd_h_ch8.appf.tab1_1_1_1_5 hd_b_ch8.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_1 hd_h_ch8.appf.tab1_1_1_2_2 hd_h_ch8.appf.tab1_1_1_2_3 hd_h_ch8.appf.tab1_1_1_2_4 hd_h_ch8.appf.tab1_1_1_2_5 hd_h_ch8.appf.tab1_1_1_2_6 hd_h_ch8.appf.tab1_1_1_2_7 hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_8 hd_h_ch8.appf.tab1_1_1_2_9 hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_10 hd_h_ch8.appf.tab1_1_1_2_11 hd_h_ch8.appf.tab1_1_1_1_4 hd_h_ch8.appf.tab1_1_1_1_5" id="hd_b_ch8.appf.tab1_1_1_9_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Functional outcomes at 1 year, score of 0-3 on mRS scale (range: 0-6, high is poor outcome)</th></tr><tr><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_1 hd_b_ch8.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_2 hd_b_ch8.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_3 hd_b_ch8.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>2</sup></td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_4 hd_b_ch8.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_5 hd_b_ch8.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_6 hd_b_ch8.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_7 hd_b_ch8.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_8 hd_b_ch8.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>126/69</p>
|
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<p>(37.7%)</p>
|
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</td><td headers="hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_9 hd_b_ch8.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">25%</td><td headers="hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_10 hd_b_ch8.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.52 (0.9 to 2.57)</td><td headers="hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_11 hd_b_ch8.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">130 more per 1000 (from 25 fewer to 392 more)</td><td headers="hd_h_ch8.appf.tab1_1_1_1_4 hd_b_ch8.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁⨁◯◯</p>
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|
<p>LOW</p>
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|
</td><td headers="hd_h_ch8.appf.tab1_1_1_1_5 hd_b_ch8.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_1 hd_h_ch8.appf.tab1_1_1_2_2 hd_h_ch8.appf.tab1_1_1_2_3 hd_h_ch8.appf.tab1_1_1_2_4 hd_h_ch8.appf.tab1_1_1_2_5 hd_h_ch8.appf.tab1_1_1_2_6 hd_h_ch8.appf.tab1_1_1_2_7 hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_8 hd_h_ch8.appf.tab1_1_1_2_9 hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_10 hd_h_ch8.appf.tab1_1_1_2_11 hd_h_ch8.appf.tab1_1_1_1_4 hd_h_ch8.appf.tab1_1_1_1_5" id="hd_b_ch8.appf.tab1_1_1_11_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Quality of Life, SF-36 mental summary (0-100), high is good outcome (follow-up 1 years)</th></tr><tr><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_1 hd_b_ch8.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_2 hd_b_ch8.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_3 hd_b_ch8.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>2</sup></td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_4 hd_b_ch8.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_5 hd_b_ch8.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_6 hd_b_ch8.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>1</sup></td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_7 hd_b_ch8.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_8 hd_b_ch8.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">23</td><td headers="hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_9 hd_b_ch8.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">12</td><td headers="hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_10 hd_b_ch8.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_11 hd_b_ch8.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 2 higher (5.92 lower to 9.92 higher)</td><td headers="hd_h_ch8.appf.tab1_1_1_1_4 hd_b_ch8.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁◯◯◯</p>
|
|
<p>VERY LOW</p>
|
|
</td><td headers="hd_h_ch8.appf.tab1_1_1_1_5 hd_b_ch8.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr><tr><th headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_1 hd_h_ch8.appf.tab1_1_1_2_2 hd_h_ch8.appf.tab1_1_1_2_3 hd_h_ch8.appf.tab1_1_1_2_4 hd_h_ch8.appf.tab1_1_1_2_5 hd_h_ch8.appf.tab1_1_1_2_6 hd_h_ch8.appf.tab1_1_1_2_7 hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_8 hd_h_ch8.appf.tab1_1_1_2_9 hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_10 hd_h_ch8.appf.tab1_1_1_2_11 hd_h_ch8.appf.tab1_1_1_1_4 hd_h_ch8.appf.tab1_1_1_1_5" id="hd_b_ch8.appf.tab1_1_1_13_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Quality of Life, SF-36 physical summary (0-100), high is good outcome (follow-up 1 years)</th></tr><tr><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_1 hd_b_ch8.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_2 hd_b_ch8.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_3 hd_b_ch8.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>2</sup></td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_4 hd_b_ch8.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_5 hd_b_ch8.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_6 hd_b_ch8.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_7 hd_b_ch8.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_8 hd_b_ch8.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">23</td><td headers="hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_9 hd_b_ch8.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">12</td><td headers="hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_10 hd_b_ch8.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_11 hd_b_ch8.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 7 lower (13.85 to 0.15 lower)</td><td headers="hd_h_ch8.appf.tab1_1_1_1_4 hd_b_ch8.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⨁⨁◯◯</p>
|
|
<p>LOW</p>
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|
</td><td headers="hd_h_ch8.appf.tab1_1_1_1_5 hd_b_ch8.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr><tr><th headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_1 hd_h_ch8.appf.tab1_1_1_2_2 hd_h_ch8.appf.tab1_1_1_2_3 hd_h_ch8.appf.tab1_1_1_2_4 hd_h_ch8.appf.tab1_1_1_2_5 hd_h_ch8.appf.tab1_1_1_2_6 hd_h_ch8.appf.tab1_1_1_2_7 hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_8 hd_h_ch8.appf.tab1_1_1_2_9 hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_10 hd_h_ch8.appf.tab1_1_1_2_11 hd_h_ch8.appf.tab1_1_1_1_4 hd_h_ch8.appf.tab1_1_1_1_5" id="hd_b_ch8.appf.tab1_1_1_15_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Quality of Life, SF-36 VAS (0-100), high is good outcome (follow-up 1 years)</th></tr><tr><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_1 hd_b_ch8.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_2 hd_b_ch8.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_3 hd_b_ch8.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>2</sup></td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_4 hd_b_ch8.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_5 hd_b_ch8.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_6 hd_b_ch8.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_ch8.appf.tab1_1_1_1_1 hd_h_ch8.appf.tab1_1_1_2_7 hd_b_ch8.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_8 hd_b_ch8.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">20</td><td headers="hd_h_ch8.appf.tab1_1_1_1_2 hd_h_ch8.appf.tab1_1_1_2_9 hd_b_ch8.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">12</td><td headers="hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_10 hd_b_ch8.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_ch8.appf.tab1_1_1_1_3 hd_h_ch8.appf.tab1_1_1_2_11 hd_b_ch8.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 7 lower (27.49 lower to 13.49 higher)</td><td headers="hd_h_ch8.appf.tab1_1_1_1_4 hd_b_ch8.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁⨁◯◯</p>
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<p>LOW</p>
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</td><td headers="hd_h_ch8.appf.tab1_1_1_1_5 hd_b_ch8.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="ch8.appf.tab1_1"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs.</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="ch8.appf.tab1_2"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias.</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="ch8.appf.tab1_3"><p class="no_margin">Control arm had zero events.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch8appftab2"><div id="ch8.appf.tab2" class="table"><h3><span class="label">Table 12</span><span class="title">Clinical evidence profile: Decompressive hemicraniectomy vs medical treatment for those over 60yrs</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577869/table/ch8.appf.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch8.appf.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch8.appf.tab2_1_1_1_1" colspan="7" rowspan="1" style="text-align:center;vertical-align:middle;">Quality assessment</th><th id="hd_h_ch8.appf.tab2_1_1_1_2" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">No of patients</th><th id="hd_h_ch8.appf.tab2_1_1_1_3" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Effect</th><th id="hd_h_ch8.appf.tab2_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch8.appf.tab2_1_1_1_4" style="text-align:center;vertical-align:middle;">Quality</th><th id="hd_h_ch8.appf.tab2_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_ch8.appf.tab2_1_1_1_5" style="text-align:center;vertical-align:middle;">Importance</th></tr><tr><th headers="hd_h_ch8.appf.tab2_1_1_1_1" id="hd_h_ch8.appf.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">No of studies</th><th headers="hd_h_ch8.appf.tab2_1_1_1_1" id="hd_h_ch8.appf.tab2_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Design</th><th headers="hd_h_ch8.appf.tab2_1_1_1_1" id="hd_h_ch8.appf.tab2_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk of bias</th><th headers="hd_h_ch8.appf.tab2_1_1_1_1" id="hd_h_ch8.appf.tab2_1_1_2_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Inconsistency</th><th headers="hd_h_ch8.appf.tab2_1_1_1_1" id="hd_h_ch8.appf.tab2_1_1_2_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Indirectness</th><th headers="hd_h_ch8.appf.tab2_1_1_1_1" id="hd_h_ch8.appf.tab2_1_1_2_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Imprecision</th><th headers="hd_h_ch8.appf.tab2_1_1_1_1" id="hd_h_ch8.appf.tab2_1_1_2_7" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Other considerations</th><th headers="hd_h_ch8.appf.tab2_1_1_1_2" id="hd_h_ch8.appf.tab2_1_1_2_8" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Decompressive Hemicraniectomy</th><th headers="hd_h_ch8.appf.tab2_1_1_1_2" id="hd_h_ch8.appf.tab2_1_1_2_9" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Medical Treatment</th><th headers="hd_h_ch8.appf.tab2_1_1_1_3" id="hd_h_ch8.appf.tab2_1_1_2_10" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Relative (95% CI)</th><th headers="hd_h_ch8.appf.tab2_1_1_1_3" id="hd_h_ch8.appf.tab2_1_1_2_11" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Absolute</th></tr></thead><tbody><tr><th headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_1 hd_h_ch8.appf.tab2_1_1_2_2 hd_h_ch8.appf.tab2_1_1_2_3 hd_h_ch8.appf.tab2_1_1_2_4 hd_h_ch8.appf.tab2_1_1_2_5 hd_h_ch8.appf.tab2_1_1_2_6 hd_h_ch8.appf.tab2_1_1_2_7 hd_h_ch8.appf.tab2_1_1_1_2 hd_h_ch8.appf.tab2_1_1_2_8 hd_h_ch8.appf.tab2_1_1_2_9 hd_h_ch8.appf.tab2_1_1_1_3 hd_h_ch8.appf.tab2_1_1_2_10 hd_h_ch8.appf.tab2_1_1_2_11 hd_h_ch8.appf.tab2_1_1_1_4 hd_h_ch8.appf.tab2_1_1_1_5" id="hd_b_ch8.appf.tab2_1_1_1_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Mortality, 6 months</th></tr><tr><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_1 hd_b_ch8.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_2 hd_b_ch8.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_3 hd_b_ch8.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_4 hd_b_ch8.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_5 hd_b_ch8.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_6 hd_b_ch8.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_7 hd_b_ch8.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch8.appf.tab2_1_1_1_2 hd_h_ch8.appf.tab2_1_1_2_8 hd_b_ch8.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>2/16</p>
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<p>(12.5%)</p>
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</td><td headers="hd_h_ch8.appf.tab2_1_1_1_2 hd_h_ch8.appf.tab2_1_1_2_9 hd_b_ch8.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">60.9%</td><td headers="hd_h_ch8.appf.tab2_1_1_1_3 hd_h_ch8.appf.tab2_1_1_2_10 hd_b_ch8.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.20 (0.05 to 0.8)</td><td headers="hd_h_ch8.appf.tab2_1_1_1_3 hd_h_ch8.appf.tab2_1_1_2_11 hd_b_ch8.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">487 fewer per 1000 (from 122 fewer to 579 fewer)</td><td headers="hd_h_ch8.appf.tab2_1_1_1_4 hd_b_ch8.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁⨁⨁◯</p>
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<p>MODERATE</p>
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</td><td headers="hd_h_ch8.appf.tab2_1_1_1_5 hd_b_ch8.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_1 hd_h_ch8.appf.tab2_1_1_2_2 hd_h_ch8.appf.tab2_1_1_2_3 hd_h_ch8.appf.tab2_1_1_2_4 hd_h_ch8.appf.tab2_1_1_2_5 hd_h_ch8.appf.tab2_1_1_2_6 hd_h_ch8.appf.tab2_1_1_2_7 hd_h_ch8.appf.tab2_1_1_1_2 hd_h_ch8.appf.tab2_1_1_2_8 hd_h_ch8.appf.tab2_1_1_2_9 hd_h_ch8.appf.tab2_1_1_1_3 hd_h_ch8.appf.tab2_1_1_2_10 hd_h_ch8.appf.tab2_1_1_2_11 hd_h_ch8.appf.tab2_1_1_1_4 hd_h_ch8.appf.tab2_1_1_1_5" id="hd_b_ch8.appf.tab2_1_1_3_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Mortality, 1 year</th></tr><tr><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_1 hd_b_ch8.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_2 hd_b_ch8.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_3 hd_b_ch8.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_4 hd_b_ch8.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_5 hd_b_ch8.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>2</sup></td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_6 hd_b_ch8.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_7 hd_b_ch8.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch8.appf.tab2_1_1_1_2 hd_h_ch8.appf.tab2_1_1_2_8 hd_b_ch8.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>29/74</p>
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<p>(39.2%)</p>
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</td><td headers="hd_h_ch8.appf.tab2_1_1_1_2 hd_h_ch8.appf.tab2_1_1_2_9 hd_b_ch8.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">75.8%</td><td headers="hd_h_ch8.appf.tab2_1_1_1_3 hd_h_ch8.appf.tab2_1_1_2_10 hd_b_ch8.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.52 (0.39 to 0.7)</td><td headers="hd_h_ch8.appf.tab2_1_1_1_3 hd_h_ch8.appf.tab2_1_1_2_11 hd_b_ch8.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">364 fewer per 1000 (from 227 fewer to 462 fewer)</td><td headers="hd_h_ch8.appf.tab2_1_1_1_4 hd_b_ch8.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
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<p>⨁⨁⨁◯</p>
|
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<p>MODERATE</p>
|
|
</td><td headers="hd_h_ch8.appf.tab2_1_1_1_5 hd_b_ch8.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_1 hd_h_ch8.appf.tab2_1_1_2_2 hd_h_ch8.appf.tab2_1_1_2_3 hd_h_ch8.appf.tab2_1_1_2_4 hd_h_ch8.appf.tab2_1_1_2_5 hd_h_ch8.appf.tab2_1_1_2_6 hd_h_ch8.appf.tab2_1_1_2_7 hd_h_ch8.appf.tab2_1_1_1_2 hd_h_ch8.appf.tab2_1_1_2_8 hd_h_ch8.appf.tab2_1_1_2_9 hd_h_ch8.appf.tab2_1_1_1_3 hd_h_ch8.appf.tab2_1_1_2_10 hd_h_ch8.appf.tab2_1_1_2_11 hd_h_ch8.appf.tab2_1_1_1_4 hd_h_ch8.appf.tab2_1_1_1_5" id="hd_b_ch8.appf.tab2_1_1_5_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Functional outcomes, 6 months, score of 0-3 on mRS scale (range: 0-6, high is poor outcome)</th></tr><tr><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_1 hd_b_ch8.appf.tab2_1_1_5_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_2 hd_b_ch8.appf.tab2_1_1_5_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_3 hd_b_ch8.appf.tab2_1_1_5_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>3</sup></td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_4 hd_b_ch8.appf.tab2_1_1_5_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_5 hd_b_ch8.appf.tab2_1_1_5_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_6 hd_b_ch8.appf.tab2_1_1_5_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>1</sup></td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_7 hd_b_ch8.appf.tab2_1_1_5_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch8.appf.tab2_1_1_1_2 hd_h_ch8.appf.tab2_1_1_2_8 hd_b_ch8.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
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<p>5/65</p>
|
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<p>(7.7%)</p>
|
|
</td><td headers="hd_h_ch8.appf.tab2_1_1_1_2 hd_h_ch8.appf.tab2_1_1_2_9 hd_b_ch8.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
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<p>2/76</p>
|
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<p>(2.6%)</p>
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</td><td headers="hd_h_ch8.appf.tab2_1_1_1_3 hd_h_ch8.appf.tab2_1_1_2_10 hd_b_ch8.appf.tab2_1_1_5_1" rowspan="2" colspan="1" style="text-align:center;vertical-align:top;">RR 2.45 (0.55 to 10.91)</td><td headers="hd_h_ch8.appf.tab2_1_1_1_3 hd_h_ch8.appf.tab2_1_1_2_11 hd_b_ch8.appf.tab2_1_1_5_1" rowspan="2" colspan="1" style="text-align:center;vertical-align:top;">23 more per 1000 (from 7 fewer to 159 more)</td><td headers="hd_h_ch8.appf.tab2_1_1_1_4 hd_b_ch8.appf.tab2_1_1_5_1" rowspan="2" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁◯◯◯</p>
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<p>VERY LOW</p>
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</td><td headers="hd_h_ch8.appf.tab2_1_1_1_5 hd_b_ch8.appf.tab2_1_1_5_1" rowspan="2" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><td headers="hd_h_ch8.appf.tab2_1_1_1_2 hd_h_ch8.appf.tab2_1_1_2_8 hd_b_ch8.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch8.appf.tab2_1_1_1_2 hd_h_ch8.appf.tab2_1_1_2_9 hd_b_ch8.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><th headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_1 hd_h_ch8.appf.tab2_1_1_2_2 hd_h_ch8.appf.tab2_1_1_2_3 hd_h_ch8.appf.tab2_1_1_2_4 hd_h_ch8.appf.tab2_1_1_2_5 hd_h_ch8.appf.tab2_1_1_2_6 hd_h_ch8.appf.tab2_1_1_2_7 hd_h_ch8.appf.tab2_1_1_1_2 hd_h_ch8.appf.tab2_1_1_2_8 hd_h_ch8.appf.tab2_1_1_2_9 hd_h_ch8.appf.tab2_1_1_1_3 hd_h_ch8.appf.tab2_1_1_2_10 hd_h_ch8.appf.tab2_1_1_2_11 hd_h_ch8.appf.tab2_1_1_1_4 hd_h_ch8.appf.tab2_1_1_1_5" id="hd_b_ch8.appf.tab2_1_1_8_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Functional outcomes, 1 year, score of 0-3 on mRS scale (range: 0-6, high is poor outcome)</th></tr><tr><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_1 hd_b_ch8.appf.tab2_1_1_8_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_2 hd_b_ch8.appf.tab2_1_1_8_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_3 hd_b_ch8.appf.tab2_1_1_8_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>3</sup></td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_4 hd_b_ch8.appf.tab2_1_1_8_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_5 hd_b_ch8.appf.tab2_1_1_8_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_6 hd_b_ch8.appf.tab2_1_1_8_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_7 hd_b_ch8.appf.tab2_1_1_8_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch8.appf.tab2_1_1_1_2 hd_h_ch8.appf.tab2_1_1_2_8 hd_b_ch8.appf.tab2_1_1_8_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>10/76</p>
|
|
<p>(13.2%)</p>
|
|
</td><td headers="hd_h_ch8.appf.tab2_1_1_1_2 hd_h_ch8.appf.tab2_1_1_2_9 hd_b_ch8.appf.tab2_1_1_8_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>3/89</p>
|
|
<p>(3.4%)</p>
|
|
</td><td headers="hd_h_ch8.appf.tab2_1_1_1_3 hd_h_ch8.appf.tab2_1_1_2_10 hd_b_ch8.appf.tab2_1_1_8_1" rowspan="2" colspan="1" style="text-align:center;vertical-align:top;">RR 3.18 (1.03 to 9.83)</td><td headers="hd_h_ch8.appf.tab2_1_1_1_3 hd_h_ch8.appf.tab2_1_1_2_11 hd_b_ch8.appf.tab2_1_1_8_1" rowspan="2" colspan="1" style="text-align:center;vertical-align:top;">100 more per 1000 (from 10 more to 180 more)<sup>4</sup></td><td headers="hd_h_ch8.appf.tab2_1_1_1_4 hd_b_ch8.appf.tab2_1_1_8_1" rowspan="2" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁⨁◯◯</p>
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<p>LOW</p>
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|
</td><td headers="hd_h_ch8.appf.tab2_1_1_1_5 hd_b_ch8.appf.tab2_1_1_8_1" rowspan="2" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><td headers="hd_h_ch8.appf.tab2_1_1_1_2 hd_h_ch8.appf.tab2_1_1_2_8 hd_b_ch8.appf.tab2_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch8.appf.tab2_1_1_1_2 hd_h_ch8.appf.tab2_1_1_2_9 hd_b_ch8.appf.tab2_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><th headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_1 hd_h_ch8.appf.tab2_1_1_2_2 hd_h_ch8.appf.tab2_1_1_2_3 hd_h_ch8.appf.tab2_1_1_2_4 hd_h_ch8.appf.tab2_1_1_2_5 hd_h_ch8.appf.tab2_1_1_2_6 hd_h_ch8.appf.tab2_1_1_2_7 hd_h_ch8.appf.tab2_1_1_1_2 hd_h_ch8.appf.tab2_1_1_2_8 hd_h_ch8.appf.tab2_1_1_2_9 hd_h_ch8.appf.tab2_1_1_1_3 hd_h_ch8.appf.tab2_1_1_2_10 hd_h_ch8.appf.tab2_1_1_2_11 hd_h_ch8.appf.tab2_1_1_1_4 hd_h_ch8.appf.tab2_1_1_1_5" id="hd_b_ch8.appf.tab2_1_1_11_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Quality of Life, 1 year, EQ-5D (Better indicated by higher values)</th></tr><tr><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_1 hd_b_ch8.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_2 hd_b_ch8.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_3 hd_b_ch8.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>3</sup></td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_4 hd_b_ch8.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_5 hd_b_ch8.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_6 hd_b_ch8.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_7 hd_b_ch8.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch8.appf.tab2_1_1_1_2 hd_h_ch8.appf.tab2_1_1_2_8 hd_b_ch8.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">42</td><td headers="hd_h_ch8.appf.tab2_1_1_1_2 hd_h_ch8.appf.tab2_1_1_2_9 hd_b_ch8.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">58</td><td headers="hd_h_ch8.appf.tab2_1_1_1_3 hd_h_ch8.appf.tab2_1_1_2_10 hd_b_ch8.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_ch8.appf.tab2_1_1_1_3 hd_h_ch8.appf.tab2_1_1_2_11 hd_b_ch8.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 0.10 higher (0 to 0.2 higher)</td><td headers="hd_h_ch8.appf.tab2_1_1_1_4 hd_b_ch8.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⨁⨁◯◯</p>
|
|
<p>LOW</p>
|
|
</td><td headers="hd_h_ch8.appf.tab2_1_1_1_5 hd_b_ch8.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr><tr><th headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_1 hd_h_ch8.appf.tab2_1_1_2_2 hd_h_ch8.appf.tab2_1_1_2_3 hd_h_ch8.appf.tab2_1_1_2_4 hd_h_ch8.appf.tab2_1_1_2_5 hd_h_ch8.appf.tab2_1_1_2_6 hd_h_ch8.appf.tab2_1_1_2_7 hd_h_ch8.appf.tab2_1_1_1_2 hd_h_ch8.appf.tab2_1_1_2_8 hd_h_ch8.appf.tab2_1_1_2_9 hd_h_ch8.appf.tab2_1_1_1_3 hd_h_ch8.appf.tab2_1_1_2_10 hd_h_ch8.appf.tab2_1_1_2_11 hd_h_ch8.appf.tab2_1_1_1_4 hd_h_ch8.appf.tab2_1_1_1_5" id="hd_b_ch8.appf.tab2_1_1_13_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Quality of Life, 1 year, EQ-5D, visual analogue scale (0-100; Better indicated by higher values)</th></tr><tr><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_1 hd_b_ch8.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_2 hd_b_ch8.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_3 hd_b_ch8.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>3</sup></td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_4 hd_b_ch8.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_5 hd_b_ch8.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_6 hd_b_ch8.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_ch8.appf.tab2_1_1_1_1 hd_h_ch8.appf.tab2_1_1_2_7 hd_b_ch8.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch8.appf.tab2_1_1_1_2 hd_h_ch8.appf.tab2_1_1_2_8 hd_b_ch8.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">42</td><td headers="hd_h_ch8.appf.tab2_1_1_1_2 hd_h_ch8.appf.tab2_1_1_2_9 hd_b_ch8.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">57</td><td headers="hd_h_ch8.appf.tab2_1_1_1_3 hd_h_ch8.appf.tab2_1_1_2_10 hd_b_ch8.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_ch8.appf.tab2_1_1_1_3 hd_h_ch8.appf.tab2_1_1_2_11 hd_b_ch8.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 16.40 higher (6.54 to 26.26 higher)</td><td headers="hd_h_ch8.appf.tab2_1_1_1_4 hd_b_ch8.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⨁⨁◯◯</p>
|
|
<p>LOW</p>
|
|
</td><td headers="hd_h_ch8.appf.tab2_1_1_1_5 hd_b_ch8.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="ch8.appf.tab2_1"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs.</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="ch8.appf.tab2_2"><p class="no_margin">Downgraded by 1 or 2 increments because the majority of the evidence included an indirect or very indirect population respectively.</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="ch8.appf.tab2_3"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias.</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="ch8.appf.tab2_4"><p class="no_margin">Calculated from risk difference.</p></div></dd></dl></dl></div></div></div></article><article data-type="fig" id="figobch8appgfig1"><div id="ch8.appg.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2015.%20Flow%20chart%20of%20health%20economic%20study%20selection%20for%20the%20guideline.&p=BOOKS&id=577869_ch8appgf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577869/bin/ch8appgf1.jpg" alt="Figure 15. Flow chart of health economic study selection for the guideline." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 15</span><span class="title">Flow chart of health economic study selection for the guideline</span></h3><div class="caption"><p>* Non-relevant population, intervention, comparison, design or setting; non-English language</p></div></div></article><article data-type="table-wrap" id="figobch8apphtab1"><div id="ch8.apph.tab1" class="table"><h3><span class="label">Table 13</span><span class="title">Studies excluded from the clinical review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577869/table/ch8.apph.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch8.apph.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Exclusion reason</th></tr></thead><tbody><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Alexander 2016<a class="bibr" href="#ch8.ref1" rid="ch8.ref1"><sup>1</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. Systematic review with references checked.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ayling 2018<a class="bibr" href="#ch8.ref2" rid="ch8.ref2"><sup>2</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. Systematic review with no RCTs.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Back 2015<a class="bibr" href="#ch8.ref3" rid="ch8.ref3"><sup>3</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-analysis with references checked.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cho 2003<a class="bibr" href="#ch8.ref5" rid="ch8.ref5"><sup>5</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect comparison.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Delgado-López 2004<a class="bibr" href="#ch8.ref9" rid="ch8.ref9"><sup>9</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not in English.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dhand 2014<a class="bibr" href="#ch8.ref10" rid="ch8.ref10"><sup>10</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison. Incorrect interventions. Correspondence.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elsawaf 2018<a class="bibr" href="#ch8.ref11" rid="ch8.ref11"><sup>11</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect comparison</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Georgiadis 2002<a class="bibr" href="#ch8.ref13" rid="ch8.ref13"><sup>13</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect interventions</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Geurts 2013<a class="bibr" href="#ch8.ref14" rid="ch8.ref14"><sup>14</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Follow up study</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gupta 2004<a class="bibr" href="#ch8.ref15" rid="ch8.ref15"><sup>15</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect interventions. Inappropriate comparison. Systematic review: study designs inappropriate.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hofmeijer 2008<a class="bibr" href="#ch8.ref16" rid="ch8.ref16"><sup>16</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Abstract only</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inamasu 2013<a class="bibr" href="#ch8.ref19" rid="ch8.ref19"><sup>19</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. Retrospective.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Juttler 2011<a class="bibr" href="#ch8.ref20" rid="ch8.ref20"><sup>20</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incomplete study. Awaiting their results.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kamran 2017<a class="bibr" href="#ch8.ref23" rid="ch8.ref23"><sup>23</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. Retrospective.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Khoozestan 2012<a class="bibr" href="#ch8.ref24" rid="ch8.ref24"><sup>24</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. Protocol.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Li 2017<a class="bibr" href="#ch8.ref25" rid="ch8.ref25"><sup>25</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. Systematic review.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lin 2016<a class="bibr" href="#ch8.ref26" rid="ch8.ref26"><sup>26</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. NRS.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lu 2014<a class="bibr" href="#ch8.ref27" rid="ch8.ref27"><sup>27</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. Systematic Review.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lucas 2012<a class="bibr" href="#ch8.ref28" rid="ch8.ref28"><sup>28</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. Observational.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Macleod 2006<a class="bibr" href="#ch8.ref29" rid="ch8.ref29"><sup>29</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. Protocol.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">McKenna 2012<a class="bibr" href="#ch8.ref30" rid="ch8.ref30"><sup>30</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mohan Rajwani 2017<a class="bibr" href="#ch8.ref31" rid="ch8.ref31"><sup>31</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. Systematic review</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Neugebauer 2012<a class="bibr" href="#ch8.ref33" rid="ch8.ref33"><sup>33</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. Protocol.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Omay 2013<a class="bibr" href="#ch8.ref34" rid="ch8.ref34"><sup>34</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. RCTs obtained.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pledl 2016<a class="bibr" href="#ch8.ref36" rid="ch8.ref36"><sup>36</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. Retrospective.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Schwab 1995<a class="bibr" href="#ch8.ref38" rid="ch8.ref38"><sup>38</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not in English.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sengeze 2014<a class="bibr" href="#ch8.ref39" rid="ch8.ref39"><sup>39</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. NRS.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Streib 2016<a class="bibr" href="#ch8.ref41" rid="ch8.ref41"><sup>41</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-analysis with references checked.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Vahedi 2004<a class="bibr" href="#ch8.ref43" rid="ch8.ref43"><sup>43</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. Trial record</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Vahedi 2005<a class="bibr" href="#ch8.ref45" rid="ch8.ref45"><sup>45</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. Abstract</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Vahedi 2007<a class="bibr" href="#ch8.ref44" rid="ch8.ref44"><sup>44</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-analysis with references checked.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Vahedi 2009<a class="bibr" href="#ch8.ref42" rid="ch8.ref42"><sup>42</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. Review</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Van Middelaar 2015<a class="bibr" href="#ch8.ref47" rid="ch8.ref47"><sup>47</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. Systematic review with not solely RCTs.</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Vibbert 2010<a class="bibr" href="#ch8.ref48" rid="ch8.ref48"><sup>48</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. Review</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Worp 2006<a class="bibr" href="#ch8.ref49" rid="ch8.ref49"><sup>49</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. Protocol</td></tr><tr><td headers="hd_h_ch8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yang 2015<a class="bibr" href="#ch8.ref50" rid="ch8.ref50"><sup>50</sup></a></td><td headers="hd_h_ch8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review with references checked.</td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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