- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04261673
Prospective Randomized Evaluation of Decompressive Ipsilateral Craniectomy for Traumatic Acute Epidural Hematoma (PREDICT-AEDH)
A Randomised Controlled Trial to Evaluate Decompressive Craniectomy for Patients With Cerebral Herniation Undergoing Evacuation of Acute Epidural Hematoma
Study Overview
Status
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Junfeng Feng, MD
- Phone Number: +8613611860825
- Email: fengjfmail@163.com
Study Locations
-
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Shanghai
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Shanghai, Shanghai, China
- Recruiting
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University
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Contact:
- Junfeng Feng
- Phone Number: +8613611860825
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Clear medical history of traumatic brain injury;
- Within 12 hours after injury;
- Unilateral mydriasis or bilateral mydriasis before the operation;
- Supratentorial acute epidural hematoma on CT scan with midline shift, which is the leading cause of operation, despite associated other lighter intracranial injury (e.g., subarachnoid hemorrhage and contusion);
- The admitting neurosurgeon considers that the epidural hematoma needs to be evacuated with a craniotomy or decompressive craniectomy.
- With informed consent.
Exclusion Criteria:
- Previous intracranial surgery prior to trauma;
- Patients with a score of 3 on the GCS, with bilateral fixed and dilated pupils, bleeding diathesis or defective coagulation, or other injuries that were deemed to be unsurvivable;
- Patients who had injury of the oculomotor nerve;
- Patients are considered to be operated mainly by following pathological change on CT: subdural hematoma, intracerebral hemorrhage, large size infarction, et al., but not because of epidural hematoma;
- Severe pre-existing disability or severe co-morbidity which would lead to a poor outcome even if the patient is supposed to a good recovery from the TBI;
- Pregnant female.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Decompressive Craniectomy
After the evacuation of epidural hematoma, the bone flap should not be replaced at the end of the operation.
|
A large bone flap must be raised.
The evacuation of epidural hematoma is depended on surgeon's preference.
The bone flap should not be replaced at the end of the operation.
DC has an advantage in controlling brain swelling, but patient is necessary to have another operation of cranioplasty to reconstruct the skull in the future.
|
Experimental: Craniotomy
After the evacuation of epidural hematoma, the bone flap must be replaced and fixed with an appropriate fixation system.
|
A large bone flap must be raised.
The evacuation of epidural hematoma is depended on surgeon's preference.
However, the bone flap must be replaced and fixed with fixation system (plates and screws).
The patient will not need an additional operation to rebuild the skull in the future.
But undisciplinable brain swelling and increased intracranial pressure may happen in some patients, and additional decompressive craniectomy is recommended in these cases.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
GOSE (extended Glasgow Outcome Scale) scores
Time Frame: 6 months post-injury
|
The primary outcome is indicated by the long-term functional outcomes, including overall mortality and the score on the "Extended Glasgow Outcome Scale" (GOS-E). "Extended Glasgow Outcome Scale" is the unabbreviated scale title, minimum value is 1 and maximum value is 8, which was scored as follows and higher scores mean a better outcome:
|
6 months post-injury
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
incidence of post-operative cerebral infarction
Time Frame: within 6 months post-injury
|
Patients have clinical deterioration after an initial surgery because of post-operative cerebral infarction.
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within 6 months post-injury
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incidence of additional craniocerebral surgery
Time Frame: within 6 months post-injury
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Patients have additional craniocerebral surgical operation as a result of clinical deterioration.
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within 6 months post-injury
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length of stay in hospital
Time Frame: within 6 months post-injury
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The length of patient's stay in hospital after initial surgery, which must due to AEDH related medical treatment.
Number of days in hospital are used to evaluate length, and patients with poor treatment effect may need longer hospital stays.
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within 6 months post-injury
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detailed economic evaluation
Time Frame: within 6 months post-injury
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Total medical expense related to treatment of AEDH, including the costs of operations, hospitalization and rehabilitation.
Different operations have different medical expense,and patients with poor treatment effect may need more medical expense.
We record and evaluate the total medical expense of the entire AEDH treatment process, within 6 months post-injury.
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within 6 months post-injury
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incidence of serious adverse events
Time Frame: within 6 months post-injury
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Serious adverse events (SAE) is defined as an untoward occurrence that:
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within 6 months post-injury
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quality of life (EQ-5D-5L)
Time Frame: at 1,3 and 6 months post-injury
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Unabbreviated scale title is "5-level EuroQol five dimensions" questionnaire.
The EQ-5D is a generic instrument for describing and valuing health.
The descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression.
Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems.
The patient is asked to indicate his/her health state by ticking the box next to the most appropriate statement in each of the five dimensions.
This decision results in a 1-digit number that expresses the level selected for that dimension.
The digits for the five dimensions can be combined into a 5-digit number that describes the patient's health state.
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at 1,3 and 6 months post-injury
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MMSE (mini-mental state examination) scores
Time Frame: at 1,3 and 6 months post-injury
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Unabbreviated scale title is "mini-mental state examination", and minimum value is 0 and maximum value is 30.
Higher scores mean a better outcome.
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at 1,3 and 6 months post-injury
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Junfeng Feng, MD, Department of Neurosurgery,Renji Hospital,School of Medicine,Shanghai Jiao Tong University
Publications and helpful links
General Publications
- Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, Servadei F, Walters BC, Wilberger JE; Surgical Management of Traumatic Brain Injury Author Group. Surgical management of acute epidural hematomas. Neurosurgery. 2006 Mar;58(3 Suppl):S7-15; discussion Si-iv.
- Li LM, Kolias AG, Guilfoyle MR, Timofeev I, Corteen EA, Pickard JD, Menon DK, Kirkpatrick PJ, Hutchinson PJ. Outcome following evacuation of acute subdural haematomas: a comparison of craniotomy with decompressive craniectomy. Acta Neurochir (Wien). 2012 Sep;154(9):1555-61. doi: 10.1007/s00701-012-1428-8. Epub 2012 Jun 30.
- Lin H, Wang WH, Hu LS, Li J, Luo F, Lin JM, Huang W, Zhang MS, Zhang Y, Hu K, Zheng JX. Novel Clinical Scale for Evaluating Pre-Operative Risk of Cerebral Herniation from Traumatic Epidural Hematoma. J Neurotrauma. 2016 Jun 1;33(11):1023-33. doi: 10.1089/neu.2014.3656. Epub 2016 Jan 28.
- Wang WH, Hu LS, Lin H, Li J, Luo F, Huang W, Lin JM, Cai GP, Liu CC. Risk factors for post-traumatic massive cerebral infarction secondary to space-occupying epidural hematoma. J Neurotrauma. 2014 Aug 15;31(16):1444-50. doi: 10.1089/neu.2013.3142. Epub 2014 Jun 25.
- Yang C, Huang X, Feng J, Xie L, Hui J, Li W, Jiang J. Prospective Randomized Evaluation of Decompressive Ipsilateral Craniectomy for Traumatic Acute Epidural Hematoma (PREDICT-AEDH): study protocol for a randomized controlled trial. Trials. 2021 Jun 29;22(1):421. doi: 10.1186/s13063-021-05359-6.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Pathologic Processes
- Cardiovascular Diseases
- Vascular Diseases
- Cerebrovascular Disorders
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Wounds and Injuries
- Hemorrhage
- Pathological Conditions, Anatomical
- Craniocerebral Trauma
- Trauma, Nervous System
- Intracranial Hemorrhages
- Intracranial Hemorrhage, Traumatic
- Hernia
- Hematoma
- Hematoma, Epidural, Cranial
- Hematoma, Epidural, Spinal
Other Study ID Numbers
- PREDICT-AEDH
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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