International variations in surgical practice for spontaneous XXXX .

@entity1 @entity772 @entity1410 @entity204 @entity1779
BACKGROUND AND PURPOSE: Spontaneous @entity1779 is a major cause of @entity204 and disability, yet there is no convincing evidence of the benefit of any medical treatment and the role of surgery remains controversial. The international randomized @entity1779 ( @entity1779 ) provided an opportunity to assess the role of surgery within the centers taking part. METHODS: Screening logs were completed to record details of all @entity1 assessed by the department, whether they were included in the trial, the reasons if they were not included, and whether they underwent surgery. RESULTS: Logs were returned by 42 centers and cover 704 months. They include details on 1578 @entity1 with characteristics comparable to @entity1779 inclusion criteria. Neurosurgeons were more likely to express clinical certainty about treatment for older @entity1 , @entity1 with a higher Glasgow @entity772 Score scale, and @entity1 in whom the @entity1410 was located on the right or in the basal ganglia or thalamus. @entity1 for whom the neurosurgeon was certain about treatment were more likely to have the @entity1410 removed if they were younger (62 versus 68 years of age), had a lower Glasgow @entity772 Scale score (10 versus 13), and had a lobar @entity1410 (49% versus 40%). The operation rate varied between 74% in Lithuania and 2% in Hungary. CONCLUSIONS: The difference in operation rates could not be explained by differences in @entity1 characteristics alone. This finding demonstrates the need for further evidence to ensure that treatment for @entity1779 is not governed by local custom.
