Clinical Scorecard: Evaluating the Alignment of Research Efforts with Clinical Needs in Chronic Subdural Hematoma: A Systematic Review Gap Analysis Based on End-User Identified Knowledge Deficits

At a Glance

Key Highlights

• CSDH incidence is rising with aging populations and is predicted to become the most common neurosurgical operation by 2030 in the USA.
• Surgical evacuation remains the gold standard for symptomatic CSDH, but non-operative management and long-term care are under-researched.
• The Improving Care in Elderly Neurosurgery Initiative (ICENI) is developing multidisciplinary clinical practice guidelines to address evidence gaps and standardize care.

Guideline-Based Recommendations

Diagnosis

• Use clinical assessment aligned with symptoms resembling a slowly evolving stroke.
• Imaging to confirm presence of chronic subdural hematoma.

Management

• Surgical evacuation is the gold standard for symptomatic CSDH.
• Consideration of adjuvant therapies such as surgical drains and steroids based on emerging evidence.
• Address non-operative management and long-term care needs, especially in frail elderly patients.

Monitoring & Follow-up

• Monitor for morbidity and mortality risks post-surgery and during disease progression.
• Long-term follow-up to manage sequelae and rehabilitation needs.

Risks

• High 1-year mortality rate up to 32%.
• Significant morbidity from both surgical intervention and disease sequelae.
• Challenges in implementation due to inconsistent study findings and gaps in research outside surgical care.

Patient & Prescribing Data

Elderly patients with symptomatic chronic subdural hematoma, often with frailty and comorbidities.

Surgical evacuation is primary; adjuvant steroid therapy and use of surgical drains are areas of active research but with inconsistent evidence affecting clinical practice.

Clinical Best Practices

• Adopt multidisciplinary approaches involving neurosurgery, geriatrics, emergency medicine, anesthesia, and general practice.
• Utilize clinical practice guidelines developed by ICENI to standardize care and address knowledge gaps.
• Prioritize targeted research to address specific clinical uncertainties, especially in non-operative and long-term management.

References

• Improving Care in Elderly Neurosurgery Initiative (ICENI) Clinical Practice Guidelines
• Fusar-Poli and Radua Guidelines on Umbrella Reviews
• National Institute of Academic Anaesthesia Funding Information