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dc.contributor.authorBrennan, Paul Men
dc.contributor.authorKolias, Angelosen
dc.contributor.authorJoannides, Alexisen
dc.contributor.authorShapey, Jonathanen
dc.contributor.authorMarcus, Hani Jen
dc.contributor.authorGregson, Barbara Aen
dc.contributor.authorGrover, Patrick Jen
dc.contributor.authorHutchinson, Peteren
dc.contributor.authorCoulter, Ian Cen
dc.contributor.authorBritish, Neurosurgical Trainee Research Collaborativeen
dc.date.accessioned2016-10-28T10:54:41Z
dc.date.available2016-10-28T10:54:41Z
dc.date.issued2016-11-11en
dc.identifier.issn0022-3085
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/260938
dc.description.abstractOBJECT: Symptomatic chronic subdural haematoma (CSDH) will become an increasingly common presentation in neurosurgical practice as the population ages, but quality evidence remains lacking to guide the optimal management of 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 UK and Ireland’s Neurosurgical Units. We 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 of CSDH. METHODS: Data on management and outcomes for patients with CSDH referred to UK and Ireland Neurosurgical Units 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 unfavourable functional status (mRS 4-6) at NSU discharge <30%. RESULTS: Data from 1205 patients in 26 NSUs were collected. Burr hole craniostomy was the most common procedure (89%) and symptomatic recurrence requiring repeat surgery within 60 days was observed in 9%. Criteria on mortality (2%), rate of recurrence (9%) and unfavourable functional outcome (22 %) were met, but morbidity was greater than expected (14%). Multivariate analysis demonstrated that failure to leave a drain intra-operatively independently predicted recurrence and unfavourable functional outcome (p=0.0 11, p=0.048, respectively). Increasing patient age (p<0·00001), post-operative bed rest (p=0.019) and use of a single burr hole (p=0.020) independently predicted unfavourable functional outcomes, but prescription of high flow oxygen or pre-operative use of anti-platelet medications did not. CONCLUSIONS: This is the largest prospective CSDH study and helps establish national standards. It has confirmed in a real-word setting the effectiveness of placing a subdural drain. Our study identified a number of modifiable prognostic factors, but questions the necessity of some common aspects of CSDH management, such as enforced post-operative bed rest. Future studies should seek to establish how we can optimise peri-operative care of patients with CSDH to reduce morbidity as well as minimize CSDH recurrence. The BNTRC is unique worldwide, conducting multi-centre trainee-led research and audit. This study demonstrates that collaborative research networks are powerful tools to interrogate clinical research questions.
dc.description.sponsorshipSociety of British Neurological Surgeons. PJH supported by NIHR Research Professorship and NIHR Cambridge Biomedical Research Centre.
dc.languageEnglishen
dc.language.isoenen
dc.publisherAmerican Association of Neurological Surgeons
dc.subjectchronic subdural haematomaen
dc.subjectneurosurgeryen
dc.subjectoutcomesen
dc.titleThe management and outcome of patients with chronic subdural haematoma: a prospective, multi-centre, observational cohort study in the United Kingdomen
dc.typeConference Object
dc.description.versionThis is the author accepted manuscript. It is permanently embargoed to comply with the publisher’s copyright terms. The final version is available via https://doi.org/10.3171/2016.8.JNS16134en
prism.publicationDate2016en
prism.publicationNameJournal of Neurosurgeryen
dc.identifier.doi10.17863/CAM.5931
dc.identifier.doi10.17863/CAM.5931
dc.identifier.doi10.17863/CAM.5931
dcterms.dateAccepted2016-08-03en
rioxxterms.versionofrecord10.3171/2016.8.JNS16134en
rioxxterms.versionAMen
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2016-11-11en
dc.contributor.orcidKolias, Angelos [0000-0003-3992-0587]
dc.contributor.orcidJoannides, Alexis [0000-0002-6618-256X]
dc.contributor.orcidHutchinson, Peter [0000-0002-2796-1835]
dc.identifier.eissn1933-0693
rioxxterms.typeConference Paper/Proceeding/Abstracten
pubs.funder-project-idNIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC) (HTA/13/15/02)
pubs.funder-project-idTCC (NIHR-RP-R3-12-013)
cam.orpheus.successThu Nov 05 11:56:25 GMT 2020 - Embargo updated*
rioxxterms.freetoread.startdate2017-11-11


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