Improving the integration of health outcomes after chronic subdural haematoma: a rapid systematic review

Chronic subdural haematoma (CSDH) is a common neurosurgical condition that is both a sentinel health event and significant public health issue. However, significant gaps exist in our understanding of adult patient outcomes following CSDH. This study synthesized the evidence regarding patient outcomes using a comprehensive theoretical model with gap-mapping to support the development of patient-informed healthcare pathways. A rapid systematic review examined two databases (MEDLINE, PsycInfo) and English language publications from 2002 to 2023 for adult patient outcomes following CSDH. Results were analyzed using narrative synthesis and gap-mapping against a six-domain positive health model incorporating bodily functions, daily functioning, mental health, quality of life, meaning and participation. Fifty-six studies, comprising 76,186 CSDH cases, were included. Most studies were rated as having low methodological quality, with the majority focusing on bodily functions, using clinician-rated measures, and examining the first six months post-CSDH. Clinician-rated outcomes of global physical disability indicated good recovery in the majority of patients (50%-98%), and moderate/moderately severe disability in 20% in the first six months. Although there was a paucity of research regarding other health domains and very limited use of patient-reported measures, these studies indicated longer-term problems, including physical disability, poorer mental health and cognitive dysfunction. CSDH is a prevalent neurosurgical condition with limited evidence for patient outcomes beyond clinician-rated outcomes of global physical disability in the acute phase. The underutilization of patient-reported outcomes and evidence-based models in research examining CSDH has seriously limited both our understanding of patient outcomes and innovations in healthcare for this vulnerable group.