Methodology: 4/5
Usefulness: 4/5

Ma L, et al. Lancet 2023 Jul 1;402(10395):27-40.

Question and Methods: Do 6 month outcomes improve after implementation of a goal-directed care bundle that corrects prognostically poor physiological abnormalities (systolic hypertension, fever, hyperglycemia, abnormal anticoagulation) for acute intracranial hemorrhage?
Findings: The authors found that of the 7036 patients enrolled at 121 hospitals, the likelihood of a poor functional outcome was lower in the care bundle group (cOR 0.86, 95% CI 0.76-0.97; p=0.015) compared with the usual care group.
Limitations: Major limitations included a high rate of loss to follow up, modified intention-to-treat analysis, and increased selection bias towards hospitals with a local champion.

Interpretation: Hospitals should incorporate this approach into clinical practice as part of active management for acute spontaneous intracerebral hemorrhage.

Dr. Samuel Wilson

JC Supervisor: Dr. Jeff Perry



  • Sam Wilson

    Dr. Wilson (Sam) is a first-year Emergency Medicine FRCPC resident at The Ottawa Hospital. Aside from EMOttawa, Sam works as the CanadiEM CJEM Infographic editor, and is interested in PoCUS, medical teaching, knowledge dissemination, and all things chess.

  • Hans Rosenberg

    Dr. Rosenberg is an emergency physician at the Ottawa Hospital, associate professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.

  • Jeff Perry

    Dr. Perry is an Emergency Physician and full Professor in the department of Epidemiology and Community Medicine. He has a special research interest in subarachnoid hemorrhage, TIA and stroke.