Neglected research in chronic subdural haematoma: systematic review of evidence gaps and their prioritisation by the improving care in elderly neurosurgery initiative (ICENI)

BackgroundChronic subdural haematoma (CSDH) is a common neurosurgical condition. Occurring predominantly in the elderly, its incidence is on the rise. A clinical practice guideline has been formed to offer best practice care recommendations and expose the key knowledge gaps for future research. This article presents the prioritised knowledge gaps. MethodForty-one clinical questions, across 11 themes were identified by a multidisciplinary guideline development groups. A comprehensive systematic literature search was performed on 1st May 2022. 6,024 articles were screened. Themes and questions for which no relevant studies were identified are presented in this study, alongside the prioritisation of knowledge gaps a multi-disciplinary guideline group, including patients. ResultsIn total, 19 of the 41 questions (46%) were identified as having no published literature applicable for review. The questions lay within seven themes - antithrombotic, communication, decision-making, transfer and pathway, palliative care, postop and recovery, and natural history. Within both the transfer and pathway, and the palliative care theme, 100% of the questioned posed had no applicable literature. The stakeholder group identified the top three priorities as Management of antithrombotics, Benefits of Protocolised Multi-disciplinary care, and Natural history of epidemiology of non-operative CSDH with a cross-cutting need for a research database supported throughout. ConclusionsDespite the high incidence of CSDH, almost half of the high priority research questions identified by the ICENI had studies in the published literature that could inform evidence-based recommendations. In particular, there is a paucity of literature surrounding conservatively managed cases, palliative care, and transfer pathways in CSDH.