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Surgery versus conservative treatment for traumatic acute subdural haematoma : a prospective, multicentre, observational, comparative effectiveness study. / CENTER-TBI Collaboration Group.

In: The Lancet Neurology, Vol. 21, No. 7, 01.07.2022, p. 620-631.

Research output: Contribution to journal › Article › Academic › peer-review

Harvard

CENTER-TBI Collaboration Group 2022, 'Surgery versus conservative treatment for traumatic acute subdural haematoma: a prospective, multicentre, observational, comparative effectiveness study', The Lancet Neurology, vol. 21, no. 7, pp. 620-631. https://doi.org/10.1016/S1474-4422(22)00166-1

APA

CENTER-TBI Collaboration Group (2022). Surgery versus conservative treatment for traumatic acute subdural haematoma: a prospective, multicentre, observational, comparative effectiveness study. The Lancet Neurology, 21(7), 620-631. https://doi.org/10.1016/S1474-4422(22)00166-1

Vancouver

CENTER-TBI Collaboration Group. Surgery versus conservative treatment for traumatic acute subdural haematoma: a prospective, multicentre, observational, comparative effectiveness study. The Lancet Neurology. 2022 Jul 1;21(7):620-631. doi: 10.1016/S1474-4422(22)00166-1

Author

CENTER-TBI Collaboration Group. / Surgery versus conservative treatment for traumatic acute subdural haematoma : a prospective, multicentre, observational, comparative effectiveness study. In: The Lancet Neurology. 2022 ; Vol. 21, No. 7. pp. 620-631.

BibTeX

@article{344ebfcc0cf446358a10e34a4071aeec,
title = "Surgery versus conservative treatment for traumatic acute subdural haematoma: a prospective, multicentre, observational, comparative effectiveness study",
abstract = "Background: Despite being well established, acute surgery in traumatic acute subdural haematoma is based on low-grade evidence. We aimed to compare the effectiveness of a strategy preferring acute surgical evacuation with one preferring initial conservative treatment in acute subdural haematoma. Methods: We did a prospective, observational, comparative effectiveness study using data from participants enrolled in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) cohort. We included patients with no pre-existing severe neurological disorders who presented with acute subdural haematoma within 24 h of traumatic brain injury. Using an instrumental variable analysis, we compared outcomes between centres according to treatment preference for acute subdural haematoma (acute surgical evacuation or initial conservative treatment), measured by the case-mix-adjusted percentage of acute surgery per centre. The primary endpoint was functional outcome at 6 months as rated with the Glasgow Outcome Scale Extended, which was estimated with ordinal regression as a common odds ratio (OR) and adjusted for prespecified confounders. Variation in centre preference was quantified with the median OR (MOR). CENTER-TBI is registered with ClinicalTrials.gov, number NCT02210221, and the Resource Identification Portal (Research Resource Identifier SCR_015582). Findings: Between Dec 19, 2014 and Dec 17, 2017, 4559 patients with traumatic brain injury were enrolled in CENTER-TBI, of whom 1407 (31%) presented with acute subdural haematoma and were included in our study. Acute surgical evacuation was done in 336 (24%) patients, by craniotomy in 245 (73%) of those patients and by decompressive craniectomy in 91 (27%). Delayed decompressive craniectomy or craniotomy after initial conservative treatment (n=982) occurred in 107 (11%) patients. The percentage of patients who underwent acute surgery ranged from 5·6% to 51·5% (IQR 12·3–35·9) between centres, with a two-times higher probability of receiving acute surgery for an identical patient in one centre versus another centre at random (adjusted MOR for acute surgery 1·8; p<0·0001]). Centre preference for acute surgery over initial conservative treatment was not associated with improvements in functional outcome (common OR per 23·6% [IQR increase] more acute surgery in a centre 0·92, 95% CI 0·77–1·09). Interpretation: Our findings show that treatment for patients with acute subdural haematoma with similar characteristics differed depending on the treating centre, because of variation in the preferred approach. A treatment strategy preferring an aggressive approach of acute surgical evacuation over initial conservative treatment was not associated with better functional outcome. Therefore, in a patient with acute subdural haematoma for whom a neurosurgeon sees no clear superiority for acute surgery over conservative treatment, initial conservative treatment might be considered. Funding: The Hersenstichting Nederland (also known as the Dutch Brain Foundation), the European Commission Seventh Framework Programme, the Hannelore Kohl Stiftung (Germany), OneMind (USA), Integra LifeSciences Corporation (USA), and NeuroTrauma Sciences (USA).",
author = "{van Essen}, {Thomas A.} and Lingsma, {Hester F.} and Dana Pisic{\u a} and Singh, {Ranjit D.} and Victor Volovici and {den Boogert}, {Hugo F.} and Alexander Younsi and Peppel, {Lianne D.} and Heijenbrok-Kal, {Majanka H.} and Ribbers, {Gerard M.} and Robert Walchenbach and Menon, {David K.} and Peter Hutchinson and Bart Depreitere and Steyerberg, {Ewout W.} and Maas, {Andrew I. R.} and {de Ruiter}, {Godard C. W.} and Peul, {Wilco C.} and {CENTER-TBI Collaboration Group} and Cecilia {\AA}kerlund and Krisztina Amrein and Nada Andelic and Lasse Andreassen and Audny Anke and Anna Antoni and Audibert, {G. rard} and Philippe Azouvi and Azzolini, {Maria Luisa} and Ronald Bartels and Barz{\'o}, {P. l} and Romuald Beauvais and Ronny Beer and Bo-Michael Bellander and Antonio Belli and Habib Benali and Maurizio Berardino and Luigi Beretta and Morten Blaabjerg and Peter Bragge and Alexandra Brazinova and Vibeke Brinck and Joanne Brooker and Camilla Brorsson and Andras Buki and Monika Bullinger and Manuel Cabeleira and Alessio Caccioppola and Emiliana Calappi and Calvi, {Maria Rosa} and Peter Cameron and {Carbayo Lozano}, Guillermo and Marco Carbonara and Casta{\~n}o-Le{\'o}n, {Ana M.} and Simona Cavallo and Giorgio Chevallard and Arturo Chieregato and Giuseppe Citerio and Hans Clusmann and Coburn, {Mark Steven} and Jonathan Coles and Cooper, {Jamie D.} and Marta Correia and Amra {\v C}ovi{\'c} and Nicola Curry and Endre Czeiter and Marek Czosnyka and Claire Dahyot-Fizelier and Paul Dark and Helen Dawes and {de Keyser}, {V. ronique} and Vincent Degos and {Della Corte}, Francesco and {\D}ula {\D}ilvesi and Abhishek Dixit and Emma Donoghue and Jens Dreier and Guy-Loup Duli{\`e}re and Ari Ercole and Patrick Esser and Erzs{\'e}bet Ezer and Martin Fabricius and Feigin, {Valery L.} and Kelly Foks and Shirin Frisvold and Alex Furmanov and Pablo Gagliardo and Damien Galanaud and Dashiell Gantner and Guoyi Gao and Pradeep George and Alexandre Ghuysen and Lelde Giga and Ben Glocker and Jago{\v s} Golubovi{\'c} and Gomez, {Pedro A.} and Johannes Gratz and Benjamin Gravesteijn and Francesca Grossi and Gruen, {Russell L.} and Deepak Gupta and Haagsma, {Juanita A.} and Iain Haitsma and Raimund Helbok and Eirik Helseth and Lindsay Horton and Jilske Huijben and Bram Jacobs and Stefan Jankowski and Mike Jarrett and Ji-yao Jiang and Faye Johnson and Kelly Jones and Mladen Karan and Kolias, {Angelos G.} and Erwin Kompanje and Daniel Kondziella and Evgenios Kornaropoulos and Lars-Owe Koskinen and No{\'e}mi Kov{\'a}cs and Alfonso Lagares and Linda Lanyon and Steven Laureys and Fiona Lecky and Didier Ledoux and Rolf Lefering and Valerie Legrand and Aurelie Lejeune and Leon Levi and Roger Lightfoot and Marc Maegele and Marek Majdan and Alex Manara and Geoffrey Manley and Hugues Mar{\'e}chal and Costanza Martino and Julia Mattern and Catherine McMahon and Melegh, {B. la} and Tomas Menovsky and Ana Mikolic and Benoit Misset and Visakh Muraleedharan and Lynnette Murray and Nandesh Nair and Ancuta Negru and David Nelson and Virginia Newcombe and Daan Nieboer and Nyir{\'a}di, {J. zsef} and Matej Oresic and Fabrizio Ortolano and Olubukola Otesile and Aarno Palotie and Parizel, {Paul M.} and Jean-Fran{\c c}ois Payen and Natascha Perera and Vincent Perlbarg and Paolo Persona and Anna Piippo-Karjalainen and Matti Pirinen and Horia Ples and Suzanne Polinder and Inigo Pomposo and Posti, {Jussi P.} and Louis Puybasset and Andreea R{\u a}doi and Arminas Ragauskas and Rahul Raj and Malinka Rambadagalla and Veronika Rehor{\v c}{\'i}kov{\'a} and {Retel Helmrich}, Isabel and Jonathan Rhodes and Sylvia Richardson and Sophie Richter and Samuli Ripatti and Saulius Rocka and Cecilie Roe and Olav Roise and Jonathan Rosand and Jeffrey Rosenfeld and Christina Rosenlund and Guy Rosenthal and Rolf Rossaint and Sandra Rossi and Daniel Rueckert and Martin Rusn{\'a}k and Juan Sahuquillo and Oliver Sakowitz and Renan Sanchez-Porras and Janos Sandor and Nadine Sch{\"a}fer and Silke Schmidt and Herbert Schoechl and Guus Schoonman and Schou, {Rico Frederik} and Elisabeth Schwendenwein and Charlie Sewalt and Toril Skandsen and Peter Smielewski and Abayomi Sorinola and Emmanuel Stamatakis and Simon Stanworth and Ana Kowark and Robert Stevens and William Stewart and Nino Stocchetti and Nina Sundstr{\"o}m and Riikka Takala and Vikt{\'o}ria Tam{\'a}s and Tomas Tamosuitis and Taylor, {Mark Steven} and {te Ao}, Braden and Olli Tenovuo and Alice Theadom and Matt Thomas and Dick Tibboel and Marjolijn Timmers and Christos Tolias and Tony Trapani and Tudora, {Cristina Maria} and Andreas Unterberg and Peter Vajkoczy and Egils Valeinis and Shirley Vallance and Zolt{\'a}n V{\'a}mos and {van der Jagt}, Mathieu and {van der Naalt}, Joukje and {van der Steen}, Gregory and {van Dijck}, {Jeroen T. J. M.} and {van Hecke}, Wim and {van Heugten}, Caroline and {van Praag}, Dominique and {van Veen}, Ernest and {van Wijk}, Roel and {Vande Vyvere}, Thijs and Alessia Vargiolu and Emmanuel Vega and Kimberley Velt and Jan Verheyden and Vespa, {Paul M.} and Anne Vik and Rimantas Vilcinis and {von Steinb{\"u}chel}, Nicole and Daphne Voormolen and Petar Vulekovic and Wang, {Kevin K. W.} and Eveline Wiegers and Guy Williams and Lindsay Wilson and Stefan Winzeck and Stefan Wolf and Zhihui Yang and Peter Yl{\'e}n and Zeiler, {Frederick A.} and Agate Ziverte and Tommaso Zoerle",
note = "Funding Information: The authors' work on this study is funded by the Hersenstichting Nederland (the Dutch Brain Foundation, grant number ps2014.06) for the Dutch Neurotraumatology Quality Registry 19 and the EU seventh Framework Programme (grant 602150) for CENTER-TBI. Additional support for CENTER-TBI was obtained from the Hannelore Kohl Stiftung (Germany), from OneMind (USA), from Integra LifeSciences Corporation (USA), and from NeuroTrauma Sciences (USA). We thank all patients for their participation in the CENTER-TBI study; and all principal investigators and researchers for their collaboration and support. Funding Information: The authors' work on this study is funded by the Hersenstichting Nederland (the Dutch Brain Foundation, grant number ps2014.06) for the Dutch Neurotraumatology Quality Registry 19 and the EU seventh Framework Programme (grant 602150) for CENTER-TBI. Additional support for CENTER-TBI was obtained from the Hannelore Kohl Stiftung (Germany), from OneMind (USA), from Integra LifeSciences Corporation (USA), and from NeuroTrauma Sciences (USA). We thank all patients for their participation in the CENTER-TBI study; and all principal investigators and researchers for their collaboration and support. Funding Information: AIRM declares consulting fees from PresSura Neuro, Integra Life Sciences, and NeuroTrauma Sciences. DKM reports grants from the UK National Institute for Health Research, during the conduct of the study; grants, personal fees, and non-financial support from GlaxoSmithKline; and personal fees from Neurotrauma Sciences, Lantmaanen AB, Pressura, and Pfizer, outside of the submitted work. EWS reports personal fees from Springer during the conduct of the study. All other authors declare no competing interests. Publisher Copyright: {\textcopyright} 2022 Elsevier Ltd",
year = "2022",
month = jul,
day = "1",
doi = "10.1016/S1474-4422(22)00166-1",
language = "English",
volume = "21",
pages = "620--631",
journal = "Lancet neurology",
issn = "1474-4422",
publisher = "Lancet Publishing Group",
number = "7",

}

RIS

TY - JOUR

T1 - Surgery versus conservative treatment for traumatic acute subdural haematoma

T2 - a prospective, multicentre, observational, comparative effectiveness study

AU - van Essen, Thomas A.

AU - Lingsma, Hester F.

AU - Pisică, Dana

AU - Singh, Ranjit D.

AU - Volovici, Victor

AU - den Boogert, Hugo F.

AU - Younsi, Alexander

AU - Peppel, Lianne D.

AU - Heijenbrok-Kal, Majanka H.

AU - Ribbers, Gerard M.

AU - Walchenbach, Robert

AU - Menon, David K.

AU - Hutchinson, Peter

AU - Depreitere, Bart

AU - Steyerberg, Ewout W.

AU - Maas, Andrew I. R.

AU - de Ruiter, Godard C. W.

AU - Peul, Wilco C.

AU - CENTER-TBI Collaboration Group

AU - Åkerlund, Cecilia

AU - Amrein, Krisztina

AU - Andelic, Nada

AU - Andreassen, Lasse

AU - Anke, Audny

AU - Antoni, Anna

AU - Audibert, G. rard

AU - Azouvi, Philippe

AU - Azzolini, Maria Luisa

AU - Bartels, Ronald

AU - Barzó, P. l

AU - Beauvais, Romuald

AU - Beer, Ronny

AU - Bellander, Bo-Michael

AU - Belli, Antonio

AU - Benali, Habib

AU - Berardino, Maurizio

AU - Beretta, Luigi

AU - Blaabjerg, Morten

AU - Bragge, Peter

AU - Brazinova, Alexandra

AU - Brinck, Vibeke

AU - Brooker, Joanne

AU - Brorsson, Camilla

AU - Buki, Andras

AU - Bullinger, Monika

AU - Cabeleira, Manuel

AU - Caccioppola, Alessio

AU - Calappi, Emiliana

AU - Calvi, Maria Rosa

AU - Cameron, Peter

AU - Carbayo Lozano, Guillermo

AU - Carbonara, Marco

AU - Castaño-León, Ana M.

AU - Cavallo, Simona

AU - Chevallard, Giorgio

AU - Chieregato, Arturo

AU - Citerio, Giuseppe

AU - Clusmann, Hans

AU - Coburn, Mark Steven

AU - Coles, Jonathan

AU - Cooper, Jamie D.

AU - Correia, Marta

AU - Čović, Amra

AU - Curry, Nicola

AU - Czeiter, Endre

AU - Czosnyka, Marek

AU - Dahyot-Fizelier, Claire

AU - Dark, Paul

AU - Dawes, Helen

AU - de Keyser, V. ronique

AU - Degos, Vincent

AU - Della Corte, Francesco

AU - Đilvesi, Đula

AU - Dixit, Abhishek

AU - Donoghue, Emma

AU - Dreier, Jens

AU - Dulière, Guy-Loup

AU - Ercole, Ari

AU - Esser, Patrick

AU - Ezer, Erzsébet

AU - Fabricius, Martin

AU - Feigin, Valery L.

AU - Foks, Kelly

AU - Frisvold, Shirin

AU - Furmanov, Alex

AU - Gagliardo, Pablo

AU - Galanaud, Damien

AU - Gantner, Dashiell

AU - Gao, Guoyi

AU - George, Pradeep

AU - Ghuysen, Alexandre

AU - Giga, Lelde

AU - Glocker, Ben

AU - Golubović, Jagoš

AU - Gomez, Pedro A.

AU - Gratz, Johannes

AU - Gravesteijn, Benjamin

AU - Grossi, Francesca

AU - Gruen, Russell L.

AU - Gupta, Deepak

AU - Haagsma, Juanita A.

AU - Haitsma, Iain

AU - Helbok, Raimund

AU - Helseth, Eirik

AU - Horton, Lindsay

AU - Huijben, Jilske

AU - Jacobs, Bram

AU - Jankowski, Stefan

AU - Jarrett, Mike

AU - Jiang, Ji-yao

AU - Johnson, Faye

AU - Jones, Kelly

AU - Karan, Mladen

AU - Kolias, Angelos G.

AU - Kompanje, Erwin

AU - Kondziella, Daniel

AU - Kornaropoulos, Evgenios

AU - Koskinen, Lars-Owe

AU - Kovács, Noémi

AU - Lagares, Alfonso

AU - Lanyon, Linda

AU - Laureys, Steven

AU - Lecky, Fiona

AU - Ledoux, Didier

AU - Lefering, Rolf

AU - Legrand, Valerie

AU - Lejeune, Aurelie

AU - Levi, Leon

AU - Lightfoot, Roger

AU - Maegele, Marc

AU - Majdan, Marek

AU - Manara, Alex

AU - Manley, Geoffrey

AU - Maréchal, Hugues

AU - Martino, Costanza

AU - Mattern, Julia

AU - McMahon, Catherine

AU - Melegh, B. la

AU - Menovsky, Tomas

AU - Mikolic, Ana

AU - Misset, Benoit

AU - Muraleedharan, Visakh

AU - Murray, Lynnette

AU - Nair, Nandesh

AU - Negru, Ancuta

AU - Nelson, David

AU - Newcombe, Virginia

AU - Nieboer, Daan

AU - Nyirádi, J. zsef

AU - Oresic, Matej

AU - Ortolano, Fabrizio

AU - Otesile, Olubukola

AU - Palotie, Aarno

AU - Parizel, Paul M.

AU - Payen, Jean-François

AU - Perera, Natascha

AU - Perlbarg, Vincent

AU - Persona, Paolo

AU - Piippo-Karjalainen, Anna

AU - Pirinen, Matti

AU - Ples, Horia

AU - Polinder, Suzanne

AU - Pomposo, Inigo

AU - Posti, Jussi P.

AU - Puybasset, Louis

AU - Rădoi, Andreea

AU - Ragauskas, Arminas

AU - Raj, Rahul

AU - Rambadagalla, Malinka

AU - Rehorčíková, Veronika

AU - Retel Helmrich, Isabel

AU - Rhodes, Jonathan

AU - Richardson, Sylvia

AU - Richter, Sophie

AU - Ripatti, Samuli

AU - Rocka, Saulius

AU - Roe, Cecilie

AU - Roise, Olav

AU - Rosand, Jonathan

AU - Rosenfeld, Jeffrey

AU - Rosenlund, Christina

AU - Rosenthal, Guy

AU - Rossaint, Rolf

AU - Rossi, Sandra

AU - Rueckert, Daniel

AU - Rusnák, Martin

AU - Sahuquillo, Juan

AU - Sakowitz, Oliver

AU - Sanchez-Porras, Renan

AU - Sandor, Janos

AU - Schäfer, Nadine

AU - Schmidt, Silke

AU - Schoechl, Herbert

AU - Schoonman, Guus

AU - Schou, Rico Frederik

AU - Schwendenwein, Elisabeth

AU - Sewalt, Charlie

AU - Skandsen, Toril

AU - Smielewski, Peter

AU - Sorinola, Abayomi

AU - Stamatakis, Emmanuel

AU - Stanworth, Simon

AU - Kowark, Ana

AU - Stevens, Robert

AU - Stewart, William

AU - Stocchetti, Nino

AU - Sundström, Nina

AU - Takala, Riikka

AU - Tamás, Viktória

AU - Tamosuitis, Tomas

AU - Taylor, Mark Steven

AU - te Ao, Braden

AU - Tenovuo, Olli

AU - Theadom, Alice

AU - Thomas, Matt

AU - Tibboel, Dick

AU - Timmers, Marjolijn

AU - Tolias, Christos

AU - Trapani, Tony

AU - Tudora, Cristina Maria

AU - Unterberg, Andreas

AU - Vajkoczy, Peter

AU - Valeinis, Egils

AU - Vallance, Shirley

AU - Vámos, Zoltán

AU - van der Jagt, Mathieu

AU - van der Naalt, Joukje

AU - van der Steen, Gregory

AU - van Dijck, Jeroen T. J. M.

AU - van Hecke, Wim

AU - van Heugten, Caroline

AU - van Praag, Dominique

AU - van Veen, Ernest

AU - van Wijk, Roel

AU - Vande Vyvere, Thijs

AU - Vargiolu, Alessia

AU - Vega, Emmanuel

AU - Velt, Kimberley

AU - Verheyden, Jan

AU - Vespa, Paul M.

AU - Vik, Anne

AU - Vilcinis, Rimantas

AU - von Steinbüchel, Nicole

AU - Voormolen, Daphne

AU - Vulekovic, Petar

AU - Wang, Kevin K. W.

AU - Wiegers, Eveline

AU - Williams, Guy

AU - Wilson, Lindsay

AU - Winzeck, Stefan

AU - Wolf, Stefan

AU - Yang, Zhihui

AU - Ylén, Peter

AU - Zeiler, Frederick A.

AU - Ziverte, Agate

AU - Zoerle, Tommaso

N1 - Funding Information: The authors' work on this study is funded by the Hersenstichting Nederland (the Dutch Brain Foundation, grant number ps2014.06) for the Dutch Neurotraumatology Quality Registry 19 and the EU seventh Framework Programme (grant 602150) for CENTER-TBI. Additional support for CENTER-TBI was obtained from the Hannelore Kohl Stiftung (Germany), from OneMind (USA), from Integra LifeSciences Corporation (USA), and from NeuroTrauma Sciences (USA). We thank all patients for their participation in the CENTER-TBI study; and all principal investigators and researchers for their collaboration and support. Funding Information: The authors' work on this study is funded by the Hersenstichting Nederland (the Dutch Brain Foundation, grant number ps2014.06) for the Dutch Neurotraumatology Quality Registry 19 and the EU seventh Framework Programme (grant 602150) for CENTER-TBI. Additional support for CENTER-TBI was obtained from the Hannelore Kohl Stiftung (Germany), from OneMind (USA), from Integra LifeSciences Corporation (USA), and from NeuroTrauma Sciences (USA). We thank all patients for their participation in the CENTER-TBI study; and all principal investigators and researchers for their collaboration and support. Funding Information: AIRM declares consulting fees from PresSura Neuro, Integra Life Sciences, and NeuroTrauma Sciences. DKM reports grants from the UK National Institute for Health Research, during the conduct of the study; grants, personal fees, and non-financial support from GlaxoSmithKline; and personal fees from Neurotrauma Sciences, Lantmaanen AB, Pressura, and Pfizer, outside of the submitted work. EWS reports personal fees from Springer during the conduct of the study. All other authors declare no competing interests. Publisher Copyright: © 2022 Elsevier Ltd

PY - 2022/7/1

Y1 - 2022/7/1

N2 - Background: Despite being well established, acute surgery in traumatic acute subdural haematoma is based on low-grade evidence. We aimed to compare the effectiveness of a strategy preferring acute surgical evacuation with one preferring initial conservative treatment in acute subdural haematoma. Methods: We did a prospective, observational, comparative effectiveness study using data from participants enrolled in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) cohort. We included patients with no pre-existing severe neurological disorders who presented with acute subdural haematoma within 24 h of traumatic brain injury. Using an instrumental variable analysis, we compared outcomes between centres according to treatment preference for acute subdural haematoma (acute surgical evacuation or initial conservative treatment), measured by the case-mix-adjusted percentage of acute surgery per centre. The primary endpoint was functional outcome at 6 months as rated with the Glasgow Outcome Scale Extended, which was estimated with ordinal regression as a common odds ratio (OR) and adjusted for prespecified confounders. Variation in centre preference was quantified with the median OR (MOR). CENTER-TBI is registered with ClinicalTrials.gov, number NCT02210221, and the Resource Identification Portal (Research Resource Identifier SCR_015582). Findings: Between Dec 19, 2014 and Dec 17, 2017, 4559 patients with traumatic brain injury were enrolled in CENTER-TBI, of whom 1407 (31%) presented with acute subdural haematoma and were included in our study. Acute surgical evacuation was done in 336 (24%) patients, by craniotomy in 245 (73%) of those patients and by decompressive craniectomy in 91 (27%). Delayed decompressive craniectomy or craniotomy after initial conservative treatment (n=982) occurred in 107 (11%) patients. The percentage of patients who underwent acute surgery ranged from 5·6% to 51·5% (IQR 12·3–35·9) between centres, with a two-times higher probability of receiving acute surgery for an identical patient in one centre versus another centre at random (adjusted MOR for acute surgery 1·8; p<0·0001]). Centre preference for acute surgery over initial conservative treatment was not associated with improvements in functional outcome (common OR per 23·6% [IQR increase] more acute surgery in a centre 0·92, 95% CI 0·77–1·09). Interpretation: Our findings show that treatment for patients with acute subdural haematoma with similar characteristics differed depending on the treating centre, because of variation in the preferred approach. A treatment strategy preferring an aggressive approach of acute surgical evacuation over initial conservative treatment was not associated with better functional outcome. Therefore, in a patient with acute subdural haematoma for whom a neurosurgeon sees no clear superiority for acute surgery over conservative treatment, initial conservative treatment might be considered. Funding: The Hersenstichting Nederland (also known as the Dutch Brain Foundation), the European Commission Seventh Framework Programme, the Hannelore Kohl Stiftung (Germany), OneMind (USA), Integra LifeSciences Corporation (USA), and NeuroTrauma Sciences (USA).

AB - Background: Despite being well established, acute surgery in traumatic acute subdural haematoma is based on low-grade evidence. We aimed to compare the effectiveness of a strategy preferring acute surgical evacuation with one preferring initial conservative treatment in acute subdural haematoma. Methods: We did a prospective, observational, comparative effectiveness study using data from participants enrolled in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) cohort. We included patients with no pre-existing severe neurological disorders who presented with acute subdural haematoma within 24 h of traumatic brain injury. Using an instrumental variable analysis, we compared outcomes between centres according to treatment preference for acute subdural haematoma (acute surgical evacuation or initial conservative treatment), measured by the case-mix-adjusted percentage of acute surgery per centre. The primary endpoint was functional outcome at 6 months as rated with the Glasgow Outcome Scale Extended, which was estimated with ordinal regression as a common odds ratio (OR) and adjusted for prespecified confounders. Variation in centre preference was quantified with the median OR (MOR). CENTER-TBI is registered with ClinicalTrials.gov, number NCT02210221, and the Resource Identification Portal (Research Resource Identifier SCR_015582). Findings: Between Dec 19, 2014 and Dec 17, 2017, 4559 patients with traumatic brain injury were enrolled in CENTER-TBI, of whom 1407 (31%) presented with acute subdural haematoma and were included in our study. Acute surgical evacuation was done in 336 (24%) patients, by craniotomy in 245 (73%) of those patients and by decompressive craniectomy in 91 (27%). Delayed decompressive craniectomy or craniotomy after initial conservative treatment (n=982) occurred in 107 (11%) patients. The percentage of patients who underwent acute surgery ranged from 5·6% to 51·5% (IQR 12·3–35·9) between centres, with a two-times higher probability of receiving acute surgery for an identical patient in one centre versus another centre at random (adjusted MOR for acute surgery 1·8; p<0·0001]). Centre preference for acute surgery over initial conservative treatment was not associated with improvements in functional outcome (common OR per 23·6% [IQR increase] more acute surgery in a centre 0·92, 95% CI 0·77–1·09). Interpretation: Our findings show that treatment for patients with acute subdural haematoma with similar characteristics differed depending on the treating centre, because of variation in the preferred approach. A treatment strategy preferring an aggressive approach of acute surgical evacuation over initial conservative treatment was not associated with better functional outcome. Therefore, in a patient with acute subdural haematoma for whom a neurosurgeon sees no clear superiority for acute surgery over conservative treatment, initial conservative treatment might be considered. Funding: The Hersenstichting Nederland (also known as the Dutch Brain Foundation), the European Commission Seventh Framework Programme, the Hannelore Kohl Stiftung (Germany), OneMind (USA), Integra LifeSciences Corporation (USA), and NeuroTrauma Sciences (USA).

UR - http://www.scopus.com/inward/record.url?scp=85132454217&partnerID=8YFLogxK

U2 - 10.1016/S1474-4422(22)00166-1

DO - 10.1016/S1474-4422(22)00166-1

M3 - Article

C2 - 35526554

VL - 21

SP - 620

EP - 631

JO - Lancet neurology

JF - Lancet neurology

SN - 1474-4422

IS - 7

ER -

ID: 25197425