The management and outcome for patients with chronic subdural hematoma: A prospective, multicenter, observational cohort study in the United Kingdom

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The management and outcome for patients with chronic subdural hematoma: A prospective, multicenter, observational cohort study in the United Kingdom. / Brennan, Paul M.; Kolias, Angelos G.; Joannides, Alexis J.; Shapey, Jonathan; Marcus, Hani J.; Gregson, Barbara A.; Grover, Patrick J.; Hutchinson, Peter J.; Coulter, Ian C.; Afshari, F. T.; Ahmed, A. I.; Alli, S.; Al-Mahfoudh, R.; Bal, J.; Belli, A.; Borg, A.; Bulters, D.; Carleton-Bland, N.; Chari, A.; Coope, D.; Cowie, C. J.; Critchley, G.; Dambatta, S.; D'Aquino, D.; Dhamija, B.; Dobson, G.; Fam, M. D.; Glancz, L.; Gray, W. P.; Halliday, J.; Hamdan, A.; Hill, C. S.; Jamjoom, A. A.B.; Jones, T. L.; Joshi, S. M.; Kailaya-Vasan, A.; Karavasili, V.; Khan, S. A.; King, A. T.; Kuenzel, A.; Livermore, L. J.; Lo, W.; Martin, J.; Matloob, S.; Mitchell, P.; Price, R.; Scotton, W.; Tarnaris, A.; Thomson, S.; Thorne, L.; British Neurosurgical Trainee Research Collaborative.

In: Journal of Neurosurgery, Vol. 127, No. 4, 01.10.2017, p. 732-739.

Research output: Contribution to journalArticlepeer-review

Harvard

Brennan, PM, Kolias, AG, Joannides, AJ, Shapey, J, Marcus, HJ, Gregson, BA, Grover, PJ, Hutchinson, PJ, Coulter, IC, Afshari, FT, Ahmed, AI, Alli, S, Al-Mahfoudh, R, Bal, J, Belli, A, Borg, A, Bulters, D, Carleton-Bland, N, Chari, A, Coope, D, Cowie, CJ, Critchley, G, Dambatta, S, D'Aquino, D, Dhamija, B, Dobson, G, Fam, MD, Glancz, L, Gray, WP, Halliday, J, Hamdan, A, Hill, CS, Jamjoom, AAB, Jones, TL, Joshi, SM, Kailaya-Vasan, A, Karavasili, V, Khan, SA, King, AT, Kuenzel, A, Livermore, LJ, Lo, W, Martin, J, Matloob, S, Mitchell, P, Price, R, Scotton, W, Tarnaris, A, Thomson, S, Thorne, L & British Neurosurgical Trainee Research Collaborative 2017, 'The management and outcome for patients with chronic subdural hematoma: A prospective, multicenter, observational cohort study in the United Kingdom', Journal of Neurosurgery, vol. 127, no. 4, pp. 732-739. https://doi.org/10.3171/2016.8.JNS16134

APA

Brennan, P. M., Kolias, A. G., Joannides, A. J., Shapey, J., Marcus, H. J., Gregson, B. A., Grover, P. J., Hutchinson, P. J., Coulter, I. C., Afshari, F. T., Ahmed, A. I., Alli, S., Al-Mahfoudh, R., Bal, J., Belli, A., Borg, A., Bulters, D., Carleton-Bland, N., Chari, A., ... British Neurosurgical Trainee Research Collaborative (2017). The management and outcome for patients with chronic subdural hematoma: A prospective, multicenter, observational cohort study in the United Kingdom. Journal of Neurosurgery, 127(4), 732-739. https://doi.org/10.3171/2016.8.JNS16134

Vancouver

Author

Brennan, Paul M. ; Kolias, Angelos G. ; Joannides, Alexis J. ; Shapey, Jonathan ; Marcus, Hani J. ; Gregson, Barbara A. ; Grover, Patrick J. ; Hutchinson, Peter J. ; Coulter, Ian C. ; Afshari, F. T. ; Ahmed, A. I. ; Alli, S. ; Al-Mahfoudh, R. ; Bal, J. ; Belli, A. ; Borg, A. ; Bulters, D. ; Carleton-Bland, N. ; Chari, A. ; Coope, D. ; Cowie, C. J. ; Critchley, G. ; Dambatta, S. ; D'Aquino, D. ; Dhamija, B. ; Dobson, G. ; Fam, M. D. ; Glancz, L. ; Gray, W. P. ; Halliday, J. ; Hamdan, A. ; Hill, C. S. ; Jamjoom, A. A.B. ; Jones, T. L. ; Joshi, S. M. ; Kailaya-Vasan, A. ; Karavasili, V. ; Khan, S. A. ; King, A. T. ; Kuenzel, A. ; Livermore, L. J. ; Lo, W. ; Martin, J. ; Matloob, S. ; Mitchell, P. ; Price, R. ; Scotton, W. ; Tarnaris, A. ; Thomson, S. ; Thorne, L. ; British Neurosurgical Trainee Research Collaborative. / The management and outcome for patients with chronic subdural hematoma: A prospective, multicenter, observational cohort study in the United Kingdom. In: Journal of Neurosurgery. 2017 ; Vol. 127, No. 4. pp. 732-739.

Bibtex

@article{3daf6b08569b40d889d9699e21aa713e,
title = "The management and outcome for patients with chronic subdural hematoma:: A prospective, multicenter, observational cohort study in the United Kingdom",
abstract = "OBJECTIVE Symptomatic chronic subdural hematoma (CSDH) will become an increasingly common presentation in neurosurgical practice as the population ages, but quality evidence is still lacking to guide the optimal management for these patients. The British Neurosurgical Trainee Research Collaborative (BNTRC) was established by neurosurgical trainees in 2012 to improve research by combining the efforts of trainees in each of the United Kingdom (UK) and Ireland's neurosurgical units (NSUs). The authors present the first study by the BNTRC that describes current management and outcomes for patients with CSDH throughout the UK and Ireland. This provides a resource both for current clinical practice and future clinical research on CSDH. METHODS Data on management and outcomes for patients with CSDH referred to UK and Ireland NSUs were collected prospectively over an 8-month period and audited against criteria predefined from the literature: NSU mortality < 5%, NSU morbidity < 10%, symptomatic recurrence within 60 days requiring repeat surgery < 20%, and unfavorable functional status (modified Rankin Scale score of 4-6) at NSU discharge < 30%. RESULTS Data from 1205 patients in 26 NSUs were collected. Bur-hole craniostomy was the most common procedure (89%), and symptomatic recurrence requiring repeat surgery within 60 days was observed in 9% of patients. Criteria on mortality (2%), rate of recurrence (9%), and unfavorable functional outcome (22%) were met, but morbidity was greater than expected (14%). Multivariate analysis demonstrated that failure to insert a drain intraoperatively independently predicted recurrence and unfavorable functional outcome (p = 0.011 and p = 0.048, respectively). Increasing patient age (p < 0.00001), postoperative bed rest (p = 0.019), and use of a single bur hole (p = 0.020) independently predicted unfavorable functional outcomes, but prescription of high-flow oxygen or preoperative use of antiplatelet medications did not. CONCLUSIONS This is the largest prospective CSDH study and helps establish national standards. It has confirmed in a real-world setting the effectiveness of placing a subdural drain. This study identified a number of modifiable prognostic factors but questions the necessity of some common aspects of CSDH management, such as enforced postoperative bed rest. Future studies should seek to establish how practitioners can optimize perioperative care of patients with CSDH to reduce morbidity as well as minimize CSDH recurrence. The BNTRC is unique worldwide, conducting multicenter trainee-led research and audits. This study demonstrates that collaborative research networks are powerful tools to interrogate clinical research questions.",
keywords = "Chronic subdural hematoma, Neurosurgery, Outcomes, Vascular disorders",
author = "Brennan, {Paul M.} and Kolias, {Angelos G.} and Joannides, {Alexis J.} and Jonathan Shapey and Marcus, {Hani J.} and Gregson, {Barbara A.} and Grover, {Patrick J.} and Hutchinson, {Peter J.} and Coulter, {Ian C.} and Afshari, {F. T.} and Ahmed, {A. I.} and S. Alli and R. Al-Mahfoudh and J. Bal and A. Belli and A. Borg and D. Bulters and N. Carleton-Bland and A. Chari and D. Coope and Cowie, {C. J.} and G. Critchley and S. Dambatta and D. D'Aquino and B. Dhamija and G. Dobson and Fam, {M. D.} and L. Glancz and Gray, {W. P.} and J. Halliday and A. Hamdan and Hill, {C. S.} and Jamjoom, {A. A.B.} and Jones, {T. L.} and Joshi, {S. M.} and A. Kailaya-Vasan and V. Karavasili and Khan, {S. A.} and King, {A. T.} and A. Kuenzel and Livermore, {L. J.} and W. Lo and J. Martin and S. Matloob and P. Mitchell and R. Price and W. Scotton and A. Tarnaris and S. Thomson and L. Thorne and {British Neurosurgical Trainee Research Collaborative}",
year = "2017",
month = oct,
day = "1",
doi = "10.3171/2016.8.JNS16134",
language = "English",
volume = "127",
pages = "732--739",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "4",

}

RIS

TY - JOUR

T1 - The management and outcome for patients with chronic subdural hematoma:

T2 - A prospective, multicenter, observational cohort study in the United Kingdom

AU - Brennan, Paul M.

AU - Kolias, Angelos G.

AU - Joannides, Alexis J.

AU - Shapey, Jonathan

AU - Marcus, Hani J.

AU - Gregson, Barbara A.

AU - Grover, Patrick J.

AU - Hutchinson, Peter J.

AU - Coulter, Ian C.

AU - Afshari, F. T.

AU - Ahmed, A. I.

AU - Alli, S.

AU - Al-Mahfoudh, R.

AU - Bal, J.

AU - Belli, A.

AU - Borg, A.

AU - Bulters, D.

AU - Carleton-Bland, N.

AU - Chari, A.

AU - Coope, D.

AU - Cowie, C. J.

AU - Critchley, G.

AU - Dambatta, S.

AU - D'Aquino, D.

AU - Dhamija, B.

AU - Dobson, G.

AU - Fam, M. D.

AU - Glancz, L.

AU - Gray, W. P.

AU - Halliday, J.

AU - Hamdan, A.

AU - Hill, C. S.

AU - Jamjoom, A. A.B.

AU - Jones, T. L.

AU - Joshi, S. M.

AU - Kailaya-Vasan, A.

AU - Karavasili, V.

AU - Khan, S. A.

AU - King, A. T.

AU - Kuenzel, A.

AU - Livermore, L. J.

AU - Lo, W.

AU - Martin, J.

AU - Matloob, S.

AU - Mitchell, P.

AU - Price, R.

AU - Scotton, W.

AU - Tarnaris, A.

AU - Thomson, S.

AU - Thorne, L.

AU - British Neurosurgical Trainee Research Collaborative

PY - 2017/10/1

Y1 - 2017/10/1

N2 - OBJECTIVE Symptomatic chronic subdural hematoma (CSDH) will become an increasingly common presentation in neurosurgical practice as the population ages, but quality evidence is still lacking to guide the optimal management for these patients. The British Neurosurgical Trainee Research Collaborative (BNTRC) was established by neurosurgical trainees in 2012 to improve research by combining the efforts of trainees in each of the United Kingdom (UK) and Ireland's neurosurgical units (NSUs). The authors present the first study by the BNTRC that describes current management and outcomes for patients with CSDH throughout the UK and Ireland. This provides a resource both for current clinical practice and future clinical research on CSDH. METHODS Data on management and outcomes for patients with CSDH referred to UK and Ireland NSUs were collected prospectively over an 8-month period and audited against criteria predefined from the literature: NSU mortality < 5%, NSU morbidity < 10%, symptomatic recurrence within 60 days requiring repeat surgery < 20%, and unfavorable functional status (modified Rankin Scale score of 4-6) at NSU discharge < 30%. RESULTS Data from 1205 patients in 26 NSUs were collected. Bur-hole craniostomy was the most common procedure (89%), and symptomatic recurrence requiring repeat surgery within 60 days was observed in 9% of patients. Criteria on mortality (2%), rate of recurrence (9%), and unfavorable functional outcome (22%) were met, but morbidity was greater than expected (14%). Multivariate analysis demonstrated that failure to insert a drain intraoperatively independently predicted recurrence and unfavorable functional outcome (p = 0.011 and p = 0.048, respectively). Increasing patient age (p < 0.00001), postoperative bed rest (p = 0.019), and use of a single bur hole (p = 0.020) independently predicted unfavorable functional outcomes, but prescription of high-flow oxygen or preoperative use of antiplatelet medications did not. CONCLUSIONS This is the largest prospective CSDH study and helps establish national standards. It has confirmed in a real-world setting the effectiveness of placing a subdural drain. This study identified a number of modifiable prognostic factors but questions the necessity of some common aspects of CSDH management, such as enforced postoperative bed rest. Future studies should seek to establish how practitioners can optimize perioperative care of patients with CSDH to reduce morbidity as well as minimize CSDH recurrence. The BNTRC is unique worldwide, conducting multicenter trainee-led research and audits. This study demonstrates that collaborative research networks are powerful tools to interrogate clinical research questions.

AB - OBJECTIVE Symptomatic chronic subdural hematoma (CSDH) will become an increasingly common presentation in neurosurgical practice as the population ages, but quality evidence is still lacking to guide the optimal management for these patients. The British Neurosurgical Trainee Research Collaborative (BNTRC) was established by neurosurgical trainees in 2012 to improve research by combining the efforts of trainees in each of the United Kingdom (UK) and Ireland's neurosurgical units (NSUs). The authors present the first study by the BNTRC that describes current management and outcomes for patients with CSDH throughout the UK and Ireland. This provides a resource both for current clinical practice and future clinical research on CSDH. METHODS Data on management and outcomes for patients with CSDH referred to UK and Ireland NSUs were collected prospectively over an 8-month period and audited against criteria predefined from the literature: NSU mortality < 5%, NSU morbidity < 10%, symptomatic recurrence within 60 days requiring repeat surgery < 20%, and unfavorable functional status (modified Rankin Scale score of 4-6) at NSU discharge < 30%. RESULTS Data from 1205 patients in 26 NSUs were collected. Bur-hole craniostomy was the most common procedure (89%), and symptomatic recurrence requiring repeat surgery within 60 days was observed in 9% of patients. Criteria on mortality (2%), rate of recurrence (9%), and unfavorable functional outcome (22%) were met, but morbidity was greater than expected (14%). Multivariate analysis demonstrated that failure to insert a drain intraoperatively independently predicted recurrence and unfavorable functional outcome (p = 0.011 and p = 0.048, respectively). Increasing patient age (p < 0.00001), postoperative bed rest (p = 0.019), and use of a single bur hole (p = 0.020) independently predicted unfavorable functional outcomes, but prescription of high-flow oxygen or preoperative use of antiplatelet medications did not. CONCLUSIONS This is the largest prospective CSDH study and helps establish national standards. It has confirmed in a real-world setting the effectiveness of placing a subdural drain. This study identified a number of modifiable prognostic factors but questions the necessity of some common aspects of CSDH management, such as enforced postoperative bed rest. Future studies should seek to establish how practitioners can optimize perioperative care of patients with CSDH to reduce morbidity as well as minimize CSDH recurrence. The BNTRC is unique worldwide, conducting multicenter trainee-led research and audits. This study demonstrates that collaborative research networks are powerful tools to interrogate clinical research questions.

KW - Chronic subdural hematoma

KW - Neurosurgery

KW - Outcomes

KW - Vascular disorders

UR - http://www.scopus.com/inward/record.url?scp=85030535716&partnerID=8YFLogxK

U2 - 10.3171/2016.8.JNS16134

DO - 10.3171/2016.8.JNS16134

M3 - Article

AN - SCOPUS:85030535716

VL - 127

SP - 732

EP - 739

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 4

ER -