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TY - JOUR

T1 - National survey on the current practice and attitudes toward the management of chronic subdural hematoma

AU - Holl, Dana C.

AU - Blaauw, Jurre

AU - Ista, Erwin

AU - Dirven, Clemens M. F.

AU - Kho, Kuan H.

AU - Jellema, Korné

AU - van der Gaag, Niels A.

AU - Miah, Ishita P.

AU - den Hertog, Heleen M.

AU - van der Naalt, Joukje

AU - Jacobs, Bram

AU - Dutch Subdural Hematoma Research group collaboration

AU - Verbaan, Dagmar

AU - Polinder, Suzanne

AU - Lingsma, Hester F.

AU - Dammers, Ruben

N1 - Publisher Copyright: © 2022 The Authors. Brain and Behavior published by Wiley Periodicals LLC.

PY - 2022/3/1

Y1 - 2022/3/1

N2 - BACKGROUND: Chronic subdural hematoma (CSDH) is a frequent pathological entity in daily clinical practice. However, evidence-based CSDH-guidelines are lacking and level I evidence from randomized clinical trials (RCTs) is limited. In order to establish and subsequently implement a guideline, insight into current clinical practice and attitudes toward CSDH-treatment is required. The aim is to explore current practice and attitudes toward CSDH-management in the Netherlands. METHODS: A national online survey was distributed among Dutch neurologists and neurosurgeons, examining variation in current CSDH-management through questions on treatment options, (peri)operative management, willingness to adopt new treatments and by presenting four CSDH-cases. RESULTS: One hundred nineteen full responses were received (8% of neurologists, N = 66 and 35% of neurosurgeons, N = 53). A majority of the respondents had a positive experience with burr-hole craniostomy (93%) and with a conservative policy (56%). Around a third had a positive experience with the use of dexamethasone as primary (30%) and additional (33.6%) treatment. These numbers were also reflected in the treatment preferences in the presented cases. (Peri)operative management corresponded among responding neurosurgeons. Most respondents would be willing to implement dexamethasone (98%) if equally effective as surgery and tranexamic acid (93%) if effective in CSDH-management. CONCLUSION: Variation was found regarding preferential CSDH-treatment. However, this is considered not to be insurmountable when implementing evidence-based treatments. This baseline inventory on current clinical practice and current attitudes toward CSDH-treatment is a stepping-stone in the eventual development and implementation of a national guideline.

AB - BACKGROUND: Chronic subdural hematoma (CSDH) is a frequent pathological entity in daily clinical practice. However, evidence-based CSDH-guidelines are lacking and level I evidence from randomized clinical trials (RCTs) is limited. In order to establish and subsequently implement a guideline, insight into current clinical practice and attitudes toward CSDH-treatment is required. The aim is to explore current practice and attitudes toward CSDH-management in the Netherlands. METHODS: A national online survey was distributed among Dutch neurologists and neurosurgeons, examining variation in current CSDH-management through questions on treatment options, (peri)operative management, willingness to adopt new treatments and by presenting four CSDH-cases. RESULTS: One hundred nineteen full responses were received (8% of neurologists, N = 66 and 35% of neurosurgeons, N = 53). A majority of the respondents had a positive experience with burr-hole craniostomy (93%) and with a conservative policy (56%). Around a third had a positive experience with the use of dexamethasone as primary (30%) and additional (33.6%) treatment. These numbers were also reflected in the treatment preferences in the presented cases. (Peri)operative management corresponded among responding neurosurgeons. Most respondents would be willing to implement dexamethasone (98%) if equally effective as surgery and tranexamic acid (93%) if effective in CSDH-management. CONCLUSION: Variation was found regarding preferential CSDH-treatment. However, this is considered not to be insurmountable when implementing evidence-based treatments. This baseline inventory on current clinical practice and current attitudes toward CSDH-treatment is a stepping-stone in the eventual development and implementation of a national guideline.

KW - chronic subdural hematoma

KW - guideline

KW - surveys and questionnaires

KW - traumatic brain injury

KW - treatment

UR - http://www.scopus.com/inward/record.url?scp=85127730091&partnerID=8YFLogxK

U2 - 10.1002/brb3.2463

DO - 10.1002/brb3.2463

M3 - Article

C2 - 35113493

VL - 12

SP - e2463

JO - Brain and behavior

JF - Brain and behavior

SN - 2162-3279

IS - 3

M1 - e2463

ER -