o drain, or not to drain, that is the question." Chronic subdural hemorrhage (SDH) or hematoma is a predominantly neurological condition usually resulting from trauma and affecting elderly individuals. 2,3,14,19 Chronic SDH is not a benign condition and is regarded as a sentinel health event because of its high morbidity and mortality rates in older people.9,18 The treatment of choice for managing chronic SDHs is surgical drainage. 12,23 Large studies have shown that older age independently contributes to increased mortality and morbidity rates after the surgical drainage of chronic SDHs. 10,22,24 As the world's elderly population increases because of adabbreviatioNs CCI = Charlson Comorbidity Index; GCS = Glasgow Coma Scale; KPS = Karnofsky Performance Scale; LOS = length of stay; SDH = subdural hemorrhage. submitted September 5, 2014. accepted December 18, 2014. iNclude wheN citiNg Published online July 10, 2015; DOI: 10.3171/2014.12.JNS142053. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. obJective Chronic subdural hemorrhage (SDH) or hematoma is a condition that affects elderly individuals. With advances in medical care, the number of nonagenarians and centenarians will increase. However, surgical treatments in this age group are associated with high rates of morbidity and mortality. Because no data are available on the rates of survival among elderly patients with chronic SDHs who undergo surgical drainage or receive only conservative care, the goal of this study was to determine survival rates in patients 90 years of age or older with symptomatic chronic SDHs. methods The authors conducted a retrospective analysis of patient data that were collected at 3 hospitals over a 13-year period (from January 2001 to June 2013). The data from patients 90 years or older with symptomatic chronic SDHs and who were offered surgical treatment were included in the analysis. Patients who underwent surgical treatment were included in the surgical group and patients who declined an operation were included in the conservative care group. The patients' Charlson Comorbidity Index score, Karnofsky Performance Scale score, dates of death, presenting symptoms, Glasgow Coma Scale score, length of stay in the hospital, discharge location, side of the SDH, and neurological improvements at 30-day and 6-month follow-ups were recorded. Data were statistically analyzed with Fisher exact test, Kaplan-Meier curves, and logistic regression. results In total, 101 patients met the inclusion criteria of this study; 70 of these patients underwent surgical drainage, and 31 received conservative care. Patients in the surgical group had statistically significantly (p < 0.001) higher survival at both the 30-day and 6-month follow-ups, with 92.9% and 81.4% of the patients in this group surviving for at least 30 days and 6 months, respectively, versus 58.1% and 41.9%, respectively, in the conservative care group. Moreover, the mean overall length o...
Background:Computed tomography (CT) scans are widely used in managing chronic subdural hematoma (CSDH). Factors that determine early post-operative volume have not been examined. The value of routine early post-operative residual volume have not been evaluated. Our study aims to compare pre-operative and early post-operative CT findings to determine the factors affecting residual hematoma and evaluate if early post-operative CT scans are useful in the management of CSDH.Methods:Forty-three patients who underwent burr hole drainage of unilateral CSDH from August 2006 to January 2013 and had routine post-operative CT scans within 48 hours of surgery were selected. Data regarding age, sex, neurological deficit, Glasgow Coma Scale (GCS), pre-existing medical conditions, use of antiplatelets or anticoagulation, operative time, usage of drains, and number of burr holes were obtained. The pre-operative CSDH volume, CSDH density, and midline shift were measured. Residual volume was calculated from early post-operative CT scans. Clinical outcome was evaluated with Glasgow Outcome Scale (GOS) at the time of discharge. Statistical analysis was performed to look for correlation between the pre-operative factors and residual volume, and the residual volume and GOS.Results:Pre-operative volume was found to correlate significantly with post-operative residual volume. There was no significant correlation between all other pre-operative factors and residual volume. There was also no correlation between residual volume and GOS at discharge.Conclusion:Routine post-operative CT brain for burr hole drainage of CSDH may be unnecessary in view of the good predictive value of pre-operative volume, and also because it is not predictive of the clinical outcome.
Kajian ini bertujuan untuk mengenal pasti tahap ketagihan internet dan perubahan tingkah laku dalam kalangan murid sekolah rendah tahap dua. Kajian ini telah dijalankan di daerah Pekan, Pahang dan melibatkan seramai 361 orang responden kajian. Instrumen yang digunakan dalam kajian ini adalah Ujian Ketagihan Internet dan soal selidik perubahan tingkah laku. Data yang dikumpul dan dianalisis dengan menggunakan perisian Special Package for the Social Statistic (SPSS) versi 27. Tahap ketagihan internet murid adalah pada tahap rendah (48.8%) dan tahap untuk perubahan tingkah laku murid juga berada di tahap rendah (58.5%). Analisis melaporkan bahawa terdapat hubungan linear positif yang kuat dan signifikan antara tahap ketagihan internet dan perubahan tingkah laku murid sekolah rendah. Kajian ini diharapkan dapat dijalankan dengan melibatkan sampel populasi yang lebih besar dan lebih menyeluruh meliputi semua peringkat usia kanak-kanak supaya boleh dijadikan sebagai panduan dan iktibar kepada para pengkaji.
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