Eighteen RCTs were included in the review (n=5,511 participants; 4,969 were included in the analysis). The number of medically treated participants included in the analysis was 3,200 compared with 1,769 surgically treated participants. Sample size ranged from 10 to 1,036. The follow-up time ranged from one to 24 months (mainly six months), where reported.
Compared with medical management, surgical treatment did not have a statistically significant effect on death and dependency (OR 0.92, 0.67 to 1.25; 18 trials).
Subgroup analyses indicated that results for morbidity and mortality were significantly better with surgery compared with medical treatment for Glasgow Coma scores of at least 6, early surgery before 24 hours (morbidity only), and haematoma volume that were greater than 40mL. Results were better for morbidity depending on the type of endoscopic approach.