Core Outcomes and Common Data Elements in Chronic Subdural Hematoma: A Systematic Review of the Literature Focusing on Baseline and Peri-Operative Care Data Elements
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Published on: March 26, 2019
Aswin Chari1, Katie C Hocking1, Ellie Edlmann1,2
11 Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge , Cambridge, United Kingdom .
Insights
Heterogeneity in chronic subdural hematoma (CSDH) research hinders treatment optimization. This study quantifies data variability, establishing a foundation for common data elements (CDEs) to improve CSDH patient outcomes.
Area of Science:
- Neurosurgery
- Clinical Epidemiology
Background:
- Chronic subdural hematoma (CSDH) is a common neurological condition, particularly in the elderly.
- Current treatment strategies are hampered by inconsistent data collection and outcome measures in research studies.
- This inconsistency prevents effective cross-study comparisons and limits evidence-based advancements.
Purpose of the Study:
- To quantify the heterogeneity of data elements collected across pre-operative, operative, and post-operative phases in CSDH research.
- To lay the groundwork for developing a standardized set of common data elements (CDEs) for CSDH research.
- To ultimately facilitate robust cross-study comparisons and improve patient care.
Main Methods:
- Systematic review adhering to PRISMA guidelines.
- Inclusion of English full-text studies published after 1990 with >10 (prospective) or >100 (retrospective) patients examining CSDH clinical outcomes.
- Analysis of 102 eligible studies to assess data element reporting variability.
Main Results:
- Significant heterogeneity was found in reporting key data elements, including presenting symptoms (39.2%), neurological status (e.g., Glasgow Coma Scale 24.5%), comorbidities (52.9%), and anticoagulant use (56.9%).
- Variability was also noted in radiological assessment methods (62.7%) and surgical details like anesthetic type (31.4% unmentioned).
- Only a minority of studies reported baseline coagulation status (17.6%).
Conclusions:
- This study confirms and quantifies substantial heterogeneity in data elements within CSDH research.
- The findings underscore the need for standardized data collection to enable meaningful comparisons between studies.
- Establishing common data elements (CDEs) is crucial for advancing CSDH research and improving patient outcomes.
Abstract:
Chronic subdural hematoma (CSDH) is an increasingly common subtype of head injury, especially in the elderly population. The optimization of treatment strategies has been hampered by the collection of heterogeneous outcome measures and data elements, precluding cross-study comparisons. This study aimed to quantify the heterogeneity of data elements in the pre-operative, operative, and post-operative phases of care, and build the basis for the development of a set of common data elements (CDEs) for CSDH. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was registered with the PROSPERO register of systematic reviews (CRD42014007266). All full-text English studies with more than 10 patients (prospective) or more than 100 patients (retrospective) published after 1990 examining clinical outcomes in CSDH were eligible for inclusion. One hundred two eligible studies were found. Only 40 studies (39.2%) reported the main presenting symptom/feature and 24 (23.5%) reported additional symptoms/features. Admitting neurological/functional status was classified by the Glasgow Coma Scale (25 studies; 24.5%), the Markwalder Score (26 studies; 25.5%) and the modified Rankin Scale (three studies; 2.9%). Fifty-four studies (52.9%) made some mention of patient comorbidities and 58 studies (56.9%) reported the proportion or excluded patients on anticoagulant medication. Eighteen studies (17.6%) reported baseline coagulation status. Sixty-four studies (62.7%) stratified or assessed severity based on radiological findings, although the methods used varied widely. There was variable reporting of surgical technique and post-operative care; 32 studies (31.4%) made no mention of whether the operations were performed under general or local anesthetic. This study, a part of the Core Outcomes and Common Data Elements in CSDH (CODE-CSDH) project, confirms and quantifies the heterogeneity of data elements collected and reported in CSDH studies to date. It establishes the basis for the consensus-based development of a set of common data elements, facilitating robust cross-study comparisons and resulting improvements in patient outcomes.
