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Search: WFRF:(Singh Ranjit D) > (2023) > Comparative effecti...

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LIBRIS Formathandbok  (Information om MARC21)
FältnamnIndikatorerMetadata
00005921naa a2200649 4500
001oai:DiVA.org:umu-221574
003SwePub
008240227s2023 | |||||||||||000 ||eng|
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-2215742 URI
0247 a https://doi.org/10.1016/j.eclinm.2023.1021612 DOI
040 a (SwePub)umu
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a van Essen, Thomas A4 aut
2451 0a Comparative effectiveness of decompressive craniectomy versus craniotomy for traumatic acute subdural hematoma (CENTER-TBI) :b an observational cohort study
264 1b Elsevier,c 2023
338 a electronic2 rdacarrier
520 a BACKGROUND: 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.
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Anestesi och intensivvård0 (SwePub)302012 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Anesthesiology and Intensive Care0 (SwePub)302012 hsv//eng
653 a Acute subdural hematoma
653 a Comparative effectiveness research
653 a Craniotomy
653 a Decompressive craniectomy
653 a Instrumental variable analysis
653 a Practice variation
7001 a van Erp, Inge A M4 aut
7001 a Lingsma, Hester F4 aut
7001 a Pisică, Dana4 aut
7001 a Yue, John K4 aut
7001 a Singh, Ranjit D4 aut
7001 a van Dijck, Jeroen T J M4 aut
7001 a Volovici, Victor4 aut
7001 a Younsi, Alexander4 aut
7001 a Kolias, Angelos4 aut
7001 a Peppel, Lianne D4 aut
7001 a Heijenbrok-Kal, Majanka4 aut
7001 a Ribbers, Gerard M4 aut
7001 a Menon, David K4 aut
7001 a Hutchinson, Peter J A4 aut
7001 a Manley, Geoffrey T4 aut
7001 a Depreitere, Bart4 aut
7001 a Steyerberg, Ewout W4 aut
7001 a Maas, Andrew I R4 aut
7001 a de Ruiter, Godard C W4 aut
7001 a Peul, Wilco C4 aut
7001 a Brorsson, Camillau Umeå universitet,Institutionen för kirurgisk och perioperativ vetenskap,CENTER-TBI4 ctb0 (Swepub:umu)brca0001
7001 a Koskinen, Lars-Owe D.,c Professor,d 1955-u Umeå universitet,Neurovetenskaper,CENTER-TBI4 ctb0 (Swepub:umu)lako0002
7001 a Sundström, Ninau Umeå universitet,Institutionen för strålningsvetenskaper,CENTER-TBI4 ctb0 (Swepub:umu)nian0004
7102 a Umeå universitetb Institutionen för kirurgisk och perioperativ vetenskap4 org
7730 t eClinicalMedicined : Elsevierg 63q 63x 2589-5370
8564 u https://doi.org/10.1016/j.eclinm.2023.102161y Fulltext
8564 u https://umu.diva-portal.org/smash/get/diva2:1840998/FULLTEXT01.pdfx primaryx Raw objecty fulltext:print
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-221574
8564 8u https://doi.org/10.1016/j.eclinm.2023.102161

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