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. 2022 Mar;12(3):e2463.
doi: 10.1002/brb3.2463. Epub 2022 Feb 3.

National survey on the current practice and attitudes toward the management of chronic subdural hematoma

Dana C Holl  1   2 , Jurre Blaauw  2   3 , Erwin Ista  4 , Clemens M F Dirven  1 , Kuan H Kho  5 , Korné Jellema  6 , Niels A van der Gaag  7 , Ishita P Miah  8 , Heleen M den Hertog  9 , Joukje van der Naalt  3 , Bram Jacobs  3 , Dagmar Verbaan  10 , Suzanne Polinder  2 , Hester F Lingsma  2 , Ruben Dammers  1 ; Dutch Subdural Hematoma Research group collaboration
Affiliations

National survey on the current practice and attitudes toward the management of chronic subdural hematoma

Dana C Holl et al. Brain Behav. 2022 Mar.

Abstract

Background: Chronic subdural hematoma (CSDH) is a frequent pathological entity in daily clinical practice. However, evidence-based CSDH-guidelines are lacking and level I evidence from randomized clinical trials (RCTs) is limited. In order to establish and subsequently implement a guideline, insight into current clinical practice and attitudes toward CSDH-treatment is required. The aim is to explore current practice and attitudes toward CSDH-management in the Netherlands.

Methods: A national online survey was distributed among Dutch neurologists and neurosurgeons, examining variation in current CSDH-management through questions on treatment options, (peri)operative management, willingness to adopt new treatments and by presenting four CSDH-cases.

Results: One hundred nineteen full responses were received (8% of neurologists, N = 66 and 35% of neurosurgeons, N = 53). A majority of the respondents had a positive experience with burr-hole craniostomy (93%) and with a conservative policy (56%). Around a third had a positive experience with the use of dexamethasone as primary (30%) and additional (33.6%) treatment. These numbers were also reflected in the treatment preferences in the presented cases. (Peri)operative management corresponded among responding neurosurgeons. Most respondents would be willing to implement dexamethasone (98%) if equally effective as surgery and tranexamic acid (93%) if effective in CSDH-management.

Conclusion: Variation was found regarding preferential CSDH-treatment. However, this is considered not to be insurmountable when implementing evidence-based treatments. This baseline inventory on current clinical practice and current attitudes toward CSDH-treatment is a stepping-stone in the eventual development and implementation of a national guideline.

Keywords: chronic subdural hematoma; guideline; surveys and questionnaires; traumatic brain injury; treatment.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Demographics of respondents to a national survey examining views of Dutch neurologists and neurosurgeons on current practice and attitudes toward the management of chronic subdural hematoma
FIGURE 2
FIGURE 2
Treatment choices in four fictitious CSDH cases which were presented to the respondents of this national survey. GCS = Glasgow Coma Scale; PR = pupillary reflex; BHC = burr‐hole craniostomy; DXM = dexamethasone; TXA = tranexamic acid; MMA = middle meningeal artery embolization
FIGURE 3
FIGURE 3
Willingness among Dutch neurologists and neurosurgeons to implement Dutch CSDH RCT results. DXM = dexamethasone; BHC = burr‐hole craniostomy; TXA = tranexamic acid
See this image and copyright information in PMC

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