Clinical practice guidelines for the care of patients with a chronic subdural haematoma: multidisciplinary recommendations from presentation to recovery
Creators: name: Stubbs, Daniel J.
name: Davies, Benjamin M.
name: Edlmann, Ellie
name: Ansari, Akbar
name: Bashford, Thomas H.
name: Braude, Philip
name: Bulters, Diederik O.
name: Camp, Sophie J.
name: Carr, Georgina
name: Coles, Jonathan P.
name: de Monteverde-Robb, David
name: Dhesi, Jugdeep
name: Dinsmore, Judith
name: Evans, Nicholas R.
name: Foster, Emily
name: Fox, Elaine
name: Froom, Ian
name: Gillespie, Conor
name: Gray, Natalie
name: Grieve, Kirsty
name: Hartley, Peter
name: Lecky, Fiona
name: Kolias, Angelos
name: Jeeves, John
name: Joannides, Alexis
name: Minett, Thais
name: Moppett, Iain
name: Nathanson, Mike H.
name: Newcombe, Virginia F. J.
name: Outtrim, Joanne G.
name: Owen, Nicola
name: Petermann, Lisa
name: Ralhan, Shvaita
name: Shipway, David
name: Sinha, Rohitashwa
name: Thomas, William
name: Whitfield, Peter C.
name: Wilson, Sally R.
name: Zolnourian, Ardalan
name: Dixon-Woods, Mary
name: Menon, David K.
name: Hutchinson, Peter J.
Publisher: name: Taylor & Francis
Year: 2024
Subjects: Medicine
Cell Biology
Neuroscience
Cancer
Science Policy
Mental Health

description: A chronic subdural haematoma (cSDH) is an encapsulated collection of fluid and blood degradation products in the subdural space. It is increasingly common, affecting older people and those living with frailty. Currently, no guidance exists to define optimal care from onset of symptoms through to recovery. This paper presents the first consensus-built recommendations for best practice in the care of cSDH, co-designed to support each stage of the patient pathway. Guideline development was led by a multidisciplinary Steering Committee with representation from diverse clinical groups, professional associations, patients, and carers. Literature searching to identify relevant evidence was guided by core clinical questions formulated through facilitated discussion with specially convened working groups. A modified Delphi exercise was undertaken to build consensus on draft statements for inclusion in the guideline using survey methodology and an in-person meeting. The proposed guideline was subsequently endorsed by the Society for British Neurological Surgeons, Neuroanaesthesia and Critical Care Society, Association of Anaesthetists, British Association of Neuroscience Nurses, British Geriatric Society, and Centre for Perioperative Care. We identified that high quality evidence was generally lacking in the literature, although randomised controlled trial (RCT) data were available to inform specific recommendations on aspects of surgical technique and use of corticosteroids. The final guideline represents the outcome of synthesising available evidence, consensus-built expert opinion and patient involvement. The guideline comprises 67 recommendations across eight major themes, covering: presentation and diagnosis, neurosurgical triage and shared decision-making, non-operative management, perioperative management (including anticoagulation), timing of surgery, intraoperative and postoperative care, rehabilitation and recovery. We present the first multidisciplinary guideline for the care of patients with cSDH. The recommendations reflect a paradigm shift in the care of cSDH, recognising and formalising the need for multidisciplinary and collaborative clinical management, communication and decision-making delivered effectively across secondary and tertiary care.