Proposal for a prospective multi-centre audit of chronic subdural haematoma management in the United Kingdom and Ireland

Abstract

BACKGROUND. Chronic subdural haematoma (CSDH) is a common condition that increases in incidence with rising age. Evacuation of a CSDH is one of the commonest neurosurgical procedures; however the optimal peri-operative management, surgical technique, post-operative care and the role of adjuvant therapies remain controversial. AIM. We propose a prospective multi-centre audit in order to establish current practices, outcomes and national benchmarks for future studies. METHODS. Neurosurgical units (NSU) in the United Kingdom and Ireland will be invited to enrol patients to this audit. All adult patients aged 16 years and over with a primary or recurrent CSDH will be eligible for inclusion. OUTCOME MEASURES AND ANALYSIS. The proposed outcome measures are (1) clinical recurrence requiring re-operation within 60 days; (2) modified Rankin scale (mRS) score at discharge from NSU; (3) morbidity and mortality in the NSU; (4) destination at discharge from NSU and (5) length of stay in the NSU. Audit standards have been derived from published systematic reviews and a recent randomised trial. The proposed standards are clinical recurrence rate < 20%; unfavourable mRS (4-6) at discharge from NSU < 30%; mortality rate in NSU < 5%; morbidity rate in NSU < 10%. Data will be submitted directly into a secure online database and analysed by the study's management group. CONCLUSIONS. The audit will determine the contemporary management and outcomes of patients with CSDH in the United Kingdom and Ireland. It will inform national guidelines, clinical practice and future studies in order to improve the outcome of patients with CSDH.

Chronic subdural haematoma: disseminating and implementing best practice

“…For example, in the multi-centre prospective observational CSDH cohort study of the British Neurosurgical Trainee Research Collaborative [7], data on 1205 patients with CSDH were collected from 26 of the 33 UK and Ireland neurosurgical units between May 2013 and January 2014. The project was driven by trainees and supported by consultants in all participating units [2]. The study found that a subdural drain was used in 85% of patients, while according to the 2006 survey 85% surgeons in the UK and the Republic of Ireland would either never use or use drains in less than a quarter of burr hole drainage operations [11]; this confirms the substantial uptake of the Cambridge CSDH trial findings across the UK [1].…”

Predictors of functional outcomes and recurrence of chronic subdural hematomas

“…In addition, there was a lack of adequate statistical power to detect a significant difference in the clinical outcomes. Therefore, caution is advised in interpreting these results, and a further larger prospective study is warranted to confirm these findings [9]. Other authors have reported that the preoperative baseline cognitive status has a significant impact on the surgical decision making [22].…”

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

“…The study protocol was approved by the Academic Committee of the Society of British Neurological Surgeons (SBNS) and has been published previously. 7 The study was supported by the SBNS and formed part of the Neurosurgical National Audit Program.…”