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001-es BibID:	BIBFORM107414
035-os BibID:	(scopus)85132454217 (wos)000833401200015
Első szerző:	van Essen, Thomas
Cím:	Surgery versus conservative treatment for traumatic acute subdural haematoma : a prospective, multicentre, observational, comparative effectiveness study / van Essen Thomas A., Lingsma Hester F., Pisica Dana, Singh Ranjit D., Volovici Victor, den Boogert Hugo F., Younsi Alexander, Peppel Lianne D., Heijenbrok-Kal Majanka H., Ribbers Gerard M., Walchenbach Robert, Menon David K., Hutchinson Peter, Depreitere Bart, Steyerberg Ewout W., Maas Andrew I. R., de Ruiter Godard C. W., Peul Wilco C., CENTER-TBI Collaboration Group
Dátum:	2022
ISSN:	1474-4422 1474-4465
Megjegyzések:	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
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban folyóiratcikk traumatic brain injury
Megjelenés:	Lancet Neurology. - 21 : 7 (2022), p. 620-631. -
További szerzők:	Lingsma, Hester Pisicǎ, Dana Singh, Ranjit D. Volovici, Victor den Boogert, Hugo F. Younsi, Alexander Peppel, Lianne D. Heijenbrok-Kal, Majanka H. Ribbers, Gerard M. Walchenbach, Robert Menon, David Krishna Hutchinson, Peter Depreitere, Bart Steyerberg, Ewout W. Maas, Andrew I. R. de Ruiter, Godard C. W. Peul, Wilco C. Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI collaborators
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