Comparative Effectiveness of Decompressive Craniectomy Versus Craniotomy for Traumatic Acute Subdural Hematoma (CENTER-TBI): An Observational Cohort Study

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aut.relation.articlenumber102161
aut.relation.endpage102161
aut.relation.journaleClinicalMedicine
aut.relation.startpage102161
aut.relation.volume63
dc.contributor.authorvan Essen, TA
dc.contributor.authorvan Erp, IAM
dc.contributor.authorLingsma, HF
dc.contributor.authorPisică, D
dc.contributor.authorYue, JK
dc.contributor.authorSingh, RD
dc.contributor.authorvan Dijck, JTJM
dc.contributor.authorVolovici, V
dc.contributor.authorYounsi, A
dc.contributor.authorKolias, A
dc.contributor.authorPeppel, LD
dc.contributor.authorHeijenbrok-Kal, M
dc.contributor.authorRibbers, GM
dc.contributor.authorMenon, DK
dc.contributor.authorHutchinson, PJA
dc.contributor.authorManley, GT
dc.contributor.authorDepreitere, B
dc.contributor.authorSteyerberg, EW
dc.contributor.authorMaas, AIR
dc.contributor.authorde Ruiter, GCW
dc.contributor.authorPeul, WC
dc.contributor.authorÅkerlund, C
dc.contributor.authorAmrein, K
dc.contributor.authorAndelic, N
dc.contributor.authorAndreassen, L
dc.contributor.authorAnke, A
dc.contributor.authorAntoni, A
dc.contributor.authorAudibert, G
dc.contributor.authorAzouvi, P
dc.contributor.authorAzzolini, ML
dc.contributor.authorBartels, R
dc.contributor.authorBarzó, P
dc.contributor.authorBeauvais, R
dc.contributor.authorBeer, R
dc.contributor.authorBellander, BM
dc.contributor.authorBelli, A
dc.contributor.authorBenali, H
dc.contributor.authorBerardino, M
dc.contributor.authorBeretta, L
dc.contributor.authorBlaabjerg, M
dc.contributor.authorBragge, P
dc.contributor.authorBrazinova, A
dc.contributor.authorBrinck, V
dc.contributor.authorBrooker, J
dc.contributor.authorBrorsson, C
dc.contributor.authorBuki, A
dc.contributor.authorBullinger, M
dc.contributor.authorCabeleira, M
dc.contributor.authorCaccioppola, A
dc.contributor.authorCalappi, E
dc.contributor.authorCalvi, MR
dc.contributor.authorCameron, P
dc.contributor.authorLozano, GC
dc.contributor.authorCarbonara, M
dc.contributor.authorCastaño-León, AM
dc.contributor.authorCavallo, S
dc.contributor.authorChevallard, G
dc.contributor.authorChieregato, A
dc.contributor.authorCiterio, G
dc.contributor.authorClusmann, H
dc.contributor.authorCoburn, MS
dc.contributor.authorColes, J
dc.contributor.authorCooper, JD
dc.contributor.authorCorreia, M
dc.contributor.authorČović, A
dc.contributor.authorCurry, N
dc.contributor.authorCzeiter, E
dc.contributor.authorCzosnyka, M
dc.contributor.authorDahyot-Fizelier, C
dc.contributor.authorDark, P
dc.contributor.authorDawes, H
dc.contributor.authorDe Keyser, V
dc.contributor.authorDegos, V
dc.contributor.authorDella Corte, F
dc.contributor.authorBoogert, HD
dc.contributor.authorĐilvesi, Đ
dc.contributor.authorDixit, A
dc.contributor.authorDonoghue, E
dc.contributor.authorDreier, J
dc.contributor.authorDulière, GL
dc.contributor.authorErcole, A
dc.contributor.authorEsser, P
dc.contributor.authorEzer, E
dc.contributor.authorFabricius, M
dc.contributor.authorFeigin, VL
dc.contributor.authorFoks, K
dc.contributor.authorFrisvold, S
dc.contributor.authorFurmanov, A
dc.contributor.authorGagliardo, P
dc.contributor.authorGalanaud, D
dc.contributor.authorGantner, D
dc.contributor.authorGao, G
dc.contributor.authorGeorge, P
dc.contributor.authorGhuysen, A
dc.contributor.authorGiga, L
dc.contributor.authorGlocker, B
dc.contributor.authorGolubović, J
dc.contributor.authorGomez, PA
dc.contributor.authorGratz, J
dc.contributor.authorGravesteijn, B
dc.date.accessioned2023-08-22T01:48:23Z
dc.date.available2023-08-22T01:48:23Z
dc.date.issued2023
dc.description.abstractBackground: Limited evidence existed on the comparative effectiveness of decompressive craniectomy (DC) versus craniotomy for evacuation of traumatic acute subdural hematoma (ASDH) until the recently published randomised clinical trial RESCUE-ASDH. In this study, that ran concurrently, we aimed to determine current practice patterns and compare outcomes of primary DC versus craniotomy. Methods: We conducted an analysis of centre treatment preference within the prospective, multicentre, observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (known as CENTER-TBI) and NeuroTraumatology Quality Registry (known as Net-QuRe) studies, which enrolled patients throughout Europe and Israel (2014–2020). We included patients with an ASDH who underwent acute neurosurgical evacuation. Patients with severe pre-existing neurological disorders were excluded. In an instrumental variable analysis, we compared outcomes between centres according to treatment preference, measured by the case-mix adjusted proportion DC per centre. The primary outcome was functional outcome rated by the 6-months Glasgow Outcome Scale Extended, estimated with ordinal regression as a common odds ratio (OR), adjusted for prespecified confounders. Variation in centre preference was quantified with the median odds ratio (MOR). CENTER-TBI is registered with ClinicalTrials.gov, number NCT02210221, and the Resource Identification Portal (Research Resource Identifier SCR_015582). Findings: Between December 19, 2014 and December 17, 2017, 4559 patients with traumatic brain injury were enrolled in CENTER-TBI of whom 336 (7%) underwent acute surgery for ASDH evacuation; 91 (27%) underwent DC and 245 (63%) craniotomy. The proportion primary DC within total acute surgery cases ranged from 6 to 67% with an interquartile range (IQR) of 12–26% among 46 centres; the odds of receiving a DC for prognostically similar patients in one centre versus another randomly selected centre were trebled (adjusted median odds ratio 2.7, p < 0.0001). Higher centre preference for DC over craniotomy was not associated with better functional outcome (adjusted common odds ratio (OR) per 14% [IQR increase] more DC in a centre = 0.9 [95% CI 0.7–1.1], n = 200). Primary DC was associated with more follow-on surgeries and complications [secondary cranial surgery 27% vs. 18%; shunts 11 vs. 5%]; and similar odds of in-hospital mortality (adjusted OR per 14% IQR more primary DC 1.3 [95% CI (1.0–3.4), n = 200]). Interpretation: We found substantial practice variation in the employment of DC over craniotomy for ASDH. This variation in treatment strategy did not result in different functional outcome. These findings suggest that primary DC should be restricted to salvageable patients in whom immediate replacement of the bone flap is not possible due to intraoperative brain swelling. Funding: Hersenstichting Nederland for the Dutch NeuroTraumatology Quality Registry and the European Union Seventh Framework Program.
dc.identifier.citationeClinicalMedicine, ISSN: 2589-5370 (Print); 2589-5370 (Online), Elsevier BV, 63, 102161-102161. doi: 10.1016/j.eclinm.2023.102161
dc.identifier.doi10.1016/j.eclinm.2023.102161
dc.identifier.issn2589-5370
dc.identifier.issn2589-5370
dc.identifier.urihttp://hdl.handle.net/10292/16586
dc.languageen
dc.publisherElsevier BV
dc.relation.urihttps://www.sciencedirect.com/science/article/pii/S2589537023003383
dc.rights.accessrightsOpenAccess
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subject32 Biomedical and Clinical Sciences
dc.subject3202 Clinical Sciences
dc.subject42 Health Sciences
dc.subjectNeurosciences
dc.subjectBrain Disorders
dc.subjectTraumatic Head and Spine Injury
dc.subjectTraumatic Brain Injury (TBI)
dc.subjectClinical Research
dc.subjectPhysical Injury - Accidents and Adverse Effects
dc.subject6.4 Surgery
dc.subject6 Evaluation of treatments and therapeutic interventions
dc.subject3 Good Health and Well Being
dc.subject3202 Clinical sciences
dc.subject4203 Health services and systems
dc.subject4206 Public health
dc.titleComparative Effectiveness of Decompressive Craniectomy Versus Craniotomy for Traumatic Acute Subdural Hematoma (CENTER-TBI): An Observational Cohort Study
dc.typeJournal Article
pubs.elements-id521292
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