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dc.contributor.authorVan Essen, Thomas
dc.contributor.authorvan Erp, Inge A. M.
dc.contributor.authorLingsma, Hester F
dc.contributor.authorPisica, Dana
dc.contributor.authorYue, John K
dc.contributor.authorSingh, Ranjit D.
dc.contributor.authorvan Dijck, Jeroen T. J. M.
dc.contributor.authorVolovici, Victor
dc.contributor.authorYounsi, Alexander
dc.contributor.authorKolias, Angelos
dc.contributor.authorPeppel, Lianne D
dc.contributor.authorHeijenbrok-Kal, Majanka H
dc.contributor.authorRibbers, Gerard M
dc.contributor.authorMenon, David K
dc.contributor.authorHutchinson, Peter J A
dc.contributor.authorManley, Geoffrey T.
dc.contributor.authorDepreitere, Bart
dc.contributor.authorSteyerberg, Ewout W
dc.contributor.authorMaas, Andrew I.R.
dc.contributor.authorde Ruiter, Godard C.W.
dc.contributor.authorPeul, Wilco C.
dc.contributor.authorÅkerlund, Cecilia
dc.contributor.authorAmrein, Krisztina
dc.contributor.authorAndelic, Nada
dc.contributor.authorAndreassen, Lasse
dc.contributor.authorAnke, Audny Gabriele Wagner
dc.contributor.authorAntoni, Anna
dc.contributor.authorAudibert, Gerard
dc.contributor.authorAzouvi, Philippe
dc.contributor.authorAzzolini, Maria Luisa
dc.contributor.authorBartels, Ronald
dc.contributor.authorBarzó, Pál
dc.contributor.authorBeauvais, Romuald
dc.contributor.authorBeer, Ronny
dc.contributor.authorBellander, Bo-Michael
dc.contributor.authorBelli, Antonio
dc.contributor.authorBenali, Habib
dc.contributor.authorBerardino, Maurizio
dc.contributor.authorBeretta, Luigi
dc.contributor.authorBlaabjerg, Morten
dc.contributor.authorBragge, Peter
dc.contributor.authorBrazinova, Alexandra
dc.contributor.authorBrinck, Vibeke
dc.contributor.authorBrooker, Joanne
dc.contributor.authorBrorsson, Camilla
dc.contributor.authorBuki, Andras
dc.contributor.authorBullinger, Monika
dc.contributor.authorCabeleira, Manuel
dc.contributor.authorCaccioppola, Alessio
dc.contributor.authorCalappi, Emiliana
dc.contributor.authorVik, Anne
dc.contributor.authorRøe, Cecilie
dc.contributor.authorRøise, Olav
dc.contributor.authorSkandsen, Toril
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, 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.en_US
dc.rightsNavngivelse 4.0 Internasjonal*
dc.titleComparative effectiveness of decompressive craniectomy versus craniotomy for traumatic acute subdural hematoma (CENTER-TBI): an observational cohort studyen_US
dc.title.alternativeComparative effectiveness of decompressive craniectomy versus craniotomy for traumatic acute subdural hematoma (CENTER-TBI): an observational cohort studyen_US
dc.typePeer revieweden_US
dc.typeJournal articleen_US

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Navngivelse 4.0 Internasjonal
Except where otherwise noted, this item's license is described as Navngivelse 4.0 Internasjonal