Protocol for the development of a multidisciplinary clinical practice guideline for the care of patients with chronic subdural haematoma

Daniel J Stubbs^{1

2}, Benjamin M Davies³, Mary Dixon-Woods⁴, Thomas H Bashford^{1

2}, Philip Braude⁵, Diedrik Bulters⁶, Sophie Camp^{7

8}, Georgina Carr⁹, Jonathan P Coles¹, Jugdeep Dhesi¹⁰, Judith Dinsmore¹¹, Ellie Edlmann¹², Nicholas R Evans¹³, Anthony Figaji¹⁴, Emily Foster¹⁵, Fiona Lecky¹⁶, Angelos Kolias³, Alexis Joannides³, Iain Moppett¹⁷, Mike Nathanson¹⁸, Virginia Newcombe¹, Nicola Owen¹⁹, Lisa Peterman²⁰, Amy Proffitt²¹, Charlotte Skiterall²², Peter Whitfield¹², Sally R Wilson²³, Ardalan Zolnourian⁶, Meriem Amarouche²⁴, Akbar Ansari⁴, Nick Borg²⁵, Paul M Brennan²⁶, Charlotte Brown²⁷, Christopher Corbett²⁸, Ruben Dammers²⁹, Tilak Das³⁰, Emily Feilding³¹, Marilise Galea⁶, Conor Gillespie³, Laurence Glancz³², Felix Gooding³³, Robert Grange⁵, Natalie Gray³⁴, Peter Hartley³⁵, Taj Hassan³⁶, Dana Holl³⁷, Julia Jones²⁴, Richard Knight³⁸, Val Luoma²³, Harry Mee³⁹, Thais Minett⁴⁰, Stephen Novak⁴¹, George Peck⁴², Shvaita Ralhan⁴³, Jennifer Ramshaw²⁷, Davina Richardson⁴⁴, Ahmed-Ramadan Sadek⁴⁵, Katie Sheehan⁴⁶, Francoise Sheppard⁴⁷, David Shipway⁵, Navneet Singh²⁴, Martin Smith⁴⁸, Rhonda Sturley⁴⁹, Michael Swart⁵⁰, William Thomas⁵¹, James Uprichard⁵², Vickie Yeardley^{8

53}, David K Menon¹, Peter J Hutchinson³

Affiliations

¹ Division of Perioperative, Acute, and Critical care, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, UK.
² Healthcare Design Group, Department of Engineering, University of Cambridge, Cambridge, UK.
³ Department of Clinical Neurosurgery, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, UK.
⁴ The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK.
⁵ Department of Medicine for Older People, North Bristol NHS Trust, Bristol, UK.
⁶ Department of Neurosurgery, University Hospital Southampton, Southampton, UK.
⁷ Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK.
⁸ Imperial College Healthcare NHS Trust, London, UK.
⁹ The Neurological Alliance, London, UK.
¹⁰ Department of Geriatric Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
¹¹ Department of Anaesthesia, St George's University NHS Trust, London, UK.
¹² Department of Neurosurgery, University Hospitals Plymouth NHS Trust, Plymouth, UK.
¹³ Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
¹⁴ Department of Neurosurgery, University of Cape Town, Cape Town, South Africa.
¹⁵ Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK.
¹⁶ Department of Emergency Medicine, University of Sheffield, Sheffield, UK.
¹⁷ Department of Anaesthesia and Perioperative Medicine, University of Nottingham, Nottingham, UK.
¹⁸ Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK.
¹⁹ Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
²⁰ ExEp Consulting, Calgary, Canada.
²¹ Department of Palliative Medicine, Barts and The London NHS Trust, London, UK.
²² Pharmacy Department, Manchester University NHS Foundation Trust, Manchester, UK.
²³ Department of Anaesthesia and Critical Care, National Hospital for Neurology and Neurosurgery, London, UK.
²⁴ Department of Neurosurgery, St George's Hospital, London, UK.
²⁵ Department of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska, USA.
²⁶ Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
²⁷ Pharmacy Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
²⁸ ACP in Emergency Medicine, Norfolk & Norwich University Hospital, Norwich, UK.
²⁹ Neurosurgeon, Erasmus MC Stroke Center, Erasmus University Medical Center, Rotterdam, The Netherlands.
³⁰ Consultant Neuroradiologist, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
³¹ Consultant Geriatrician (Major Trauma), Salford Royal Hospital, Salford, UK.
³² Department of Neurosurgery, Nottingham University Hospitals NHS Trust, Nottingham, UK.
³³ Department of Emergency Medicine, St Thomas' Hospital, London, UK.
³⁴ Department of Physiotherapy, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
³⁵ Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
³⁶ Department of Emergency Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
³⁷ Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands.
³⁸ The Burwell Surgery, Cambridge, UK.
³⁹ Department of Rehabilitation Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁴⁰ Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁴¹ Department of Rehabilitation Medicine, North Bristol NHS Trust, Bristol, UK.
⁴² Department of Geriatric Medicine, Imperial College London, London, UK.
⁴³ Department of Geriatric Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁴⁴ Department of Neurosciences, Imperial College Healthcare NHS Trust, London, UK.
⁴⁵ Department of Neurosurgery, Barking Havering Redbridge University Trust, Romford, UK.
⁴⁶ Rehabilitation and Health Services Research, Kings College, London, UK.
⁴⁷ Department of Emergency Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
⁴⁸ Department of Emergency Medicine, Salford Royal NHS Foundation Trust, Salford, UK.
⁴⁹ Department of Geriatric Medicine, St George's, University of London, London, UK.
⁵⁰ Department of Anaesthesia, Torbay and South Devon NHS Foundation Trust, Torquay, UK.
⁵¹ Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁵² Department of Haematology, St George's Hospital, London, UK.
⁵³ Central London Community Healthcare NHS Trust, London, UK.

PMID: 38434734
PMCID: PMC10905132
DOI: 10.12688/wellcomeopenres.18478.1

Protocol for the development of a multidisciplinary clinical practice guideline for the care of patients with chronic subdural haematoma

Daniel J Stubbs et al. Wellcome Open Res. 2023.

. 2023 Sep 1:8:390.

doi: 10.12688/wellcomeopenres.18478.1. eCollection 2023.

Authors

Affiliations

¹ Division of Perioperative, Acute, and Critical care, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, UK.
² Healthcare Design Group, Department of Engineering, University of Cambridge, Cambridge, UK.
³ Department of Clinical Neurosurgery, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, UK.
⁴ The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK.
⁵ Department of Medicine for Older People, North Bristol NHS Trust, Bristol, UK.
⁶ Department of Neurosurgery, University Hospital Southampton, Southampton, UK.
⁷ Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK.
⁸ Imperial College Healthcare NHS Trust, London, UK.
⁹ The Neurological Alliance, London, UK.
¹⁰ Department of Geriatric Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
¹¹ Department of Anaesthesia, St George's University NHS Trust, London, UK.
¹² Department of Neurosurgery, University Hospitals Plymouth NHS Trust, Plymouth, UK.
¹³ Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
¹⁴ Department of Neurosurgery, University of Cape Town, Cape Town, South Africa.
¹⁵ Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK.
¹⁶ Department of Emergency Medicine, University of Sheffield, Sheffield, UK.
¹⁷ Department of Anaesthesia and Perioperative Medicine, University of Nottingham, Nottingham, UK.
¹⁸ Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK.
¹⁹ Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
²⁰ ExEp Consulting, Calgary, Canada.
²¹ Department of Palliative Medicine, Barts and The London NHS Trust, London, UK.
²² Pharmacy Department, Manchester University NHS Foundation Trust, Manchester, UK.
²³ Department of Anaesthesia and Critical Care, National Hospital for Neurology and Neurosurgery, London, UK.
²⁴ Department of Neurosurgery, St George's Hospital, London, UK.
²⁵ Department of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska, USA.
²⁶ Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
²⁷ Pharmacy Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
²⁸ ACP in Emergency Medicine, Norfolk & Norwich University Hospital, Norwich, UK.
²⁹ Neurosurgeon, Erasmus MC Stroke Center, Erasmus University Medical Center, Rotterdam, The Netherlands.
³⁰ Consultant Neuroradiologist, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
³¹ Consultant Geriatrician (Major Trauma), Salford Royal Hospital, Salford, UK.
³² Department of Neurosurgery, Nottingham University Hospitals NHS Trust, Nottingham, UK.
³³ Department of Emergency Medicine, St Thomas' Hospital, London, UK.
³⁴ Department of Physiotherapy, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
³⁵ Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
³⁶ Department of Emergency Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
³⁷ Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands.
³⁸ The Burwell Surgery, Cambridge, UK.
³⁹ Department of Rehabilitation Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁴⁰ Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁴¹ Department of Rehabilitation Medicine, North Bristol NHS Trust, Bristol, UK.
⁴² Department of Geriatric Medicine, Imperial College London, London, UK.
⁴³ Department of Geriatric Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁴⁴ Department of Neurosciences, Imperial College Healthcare NHS Trust, London, UK.
⁴⁵ Department of Neurosurgery, Barking Havering Redbridge University Trust, Romford, UK.
⁴⁶ Rehabilitation and Health Services Research, Kings College, London, UK.
⁴⁷ Department of Emergency Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
⁴⁸ Department of Emergency Medicine, Salford Royal NHS Foundation Trust, Salford, UK.
⁴⁹ Department of Geriatric Medicine, St George's, University of London, London, UK.
⁵⁰ Department of Anaesthesia, Torbay and South Devon NHS Foundation Trust, Torquay, UK.
⁵¹ Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁵² Department of Haematology, St George's Hospital, London, UK.
⁵³ Central London Community Healthcare NHS Trust, London, UK.

PMID: 38434734
PMCID: PMC10905132
DOI: 10.12688/wellcomeopenres.18478.1

Abstract

Introduction: A common neurosurgical condition, chronic subdural haematoma (cSDH) typically affects older people with other underlying health conditions. The care of this potentially vulnerable cohort is often, however, fragmented and suboptimal. In other complex conditions, multidisciplinary guidelines have transformed patient experience and outcomes, but no such framework exists for cSDH. This paper outlines a protocol to develop the first comprehensive multidisciplinary guideline from diagnosis to long-term recovery with cSDH. Methods: The project will be guided by a steering group of key stakeholders and professional organisations and will feature patient and public involvement. Multidisciplinary thematic working groups will examine key aspects of care to formulate appropriate, patient-centered research questions, targeted with evidence review using the GRADE framework. The working groups will then formulate draft clinical recommendations to be used in a modified Delphi process to build consensus on guideline contents. Conclusions: We present a protocol for the development of a multidisciplinary guideline to inform the care of patients with a cSDH, developed by cross-disciplinary working groups and arrived at through a consensus-building process, including a modified online Delphi.

Keywords: Chronic Subdural Haematoma; Clinical Practice Guideline; Neurosurgery; Perioperative Medicine; Protocol.

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Conflict of interest statement

No competing interests were disclosed.

Figures

**Figure 1.. Flowchart of guideline development.**
Key methodological stages are shown in grey-bordered boxes, deliverables at each stage in orange-bordered. *WG = Working group*.

**Figure 2.. Translating draft recommendations from working groups into a final clinical practice guideline.**
Draft statements from working group meetings will be prioritised for inclusion in final guideline through an online Delphi consensus-building exercise, selection and finalisation by the ICENI steering group (yellow boxes), and a subsequent feedback and refinement on implementation and feasibility from external stakeholders. Red boxes indicate use of the Thiscovery platform.

See this image and copyright information in PMC

References

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Protocol for the development of a multidisciplinary clinical practice guideline for the care of patients with chronic subdural haematoma

Affiliations

Protocol for the development of a multidisciplinary clinical practice guideline for the care of patients with chronic subdural haematoma

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources