Citation

Chari A, Hocking K, Edlmann E, Turner C, Santarius T, Hutchinson PJ, Kolias AG. J. Neurotrauma 2015; 33(17): 1569-1575.

Affiliation

Addenbrooke's Hospital & University of Cambridge, Academic Division of Neurosurgery , Addenbrooke's Hospital & University of Cambridge , Cambridge, United Kingdom , CB2 0QQ ; angeloskolias@gmail.com.

Copyright

(Copyright © 2015, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2015.4248

PMID

26541092

Abstract

Chronic subdural hematoma (CSDH) is an increasingly common subtype of head injury, especially in the elderly population. The optimisation of treatment strategies has been hampered by the collection of heterogeneous outcome measures and data elements, precluding cross-study comparisons. This study aimed to quantify the heterogeneity of data elements in the pre-operative, operative and post-operative phases of care and build the basis for the development of a set of common data elements (CDEs) for CSDH. This systematic review adhered to the PRISMA statement and was registered with the PROSPERO register of systematic reviews (CRD42014007266). All full text English studies with >10 patients (prospective) or >100 patients (retrospective) published after 1990 examining clinical outcomes in CSDH were eligible for inclusion. One hundred and two eligible studies were found. Only 40 studies (39.2%) reported the main presenting symptom/feature and 24 (23.5%) reported additional symptoms/features. Admitting neurological/functional status was classified by the Glasgow Coma Scale (GCS)(25 studies, 24.5%), the Markwalder Score (26, 25.5%) and the modified Rankin Scale (mRS)(3, 2.9%). Fifty-four studies (52.9%) made some mention of patient co-morbidities and 58 studies (56.9%) reported the proportion or excluded patients on anticoagulant medication. Eighteen (17.6%) studies reported baseline coagulation status. Sixty-four (62.7%) studies stratified or assessed severity based on radiological findings, although the methods used varied widely. There was variable reporting of surgical technique and post-operative care; 32 studies (31.4%) made no mention of whether the operations were performed under general or local anaesthetic. This study, a part of the Core Outcomes and Common Data Elements in CSDH (CODE-CSDH) project, confirms and quantifies the heterogeneity of data elements collected and reported in CSDH studies to date. It establishes the basis for the consensus-based development of a set of common data elements, facilitating robust cross-study comparisons and resulting improvements in patient outcomes.

Language: en