Actual and projected incidence rates for chronic subdural hematomas in United States Veterans Administration and civilian populations

Balser, David; Farooq, Sameer; Mehmood, Talha; Reyes, Marleen; Samadani, Uzma

doi:10.3171/2014.9.jns141550

Cited by 235 publications

(184 citation statements)

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“…3 A study from the United States also showed an increase in the incidence rates of subacute or chronic subdural hematoma, and the researchers predicted that subacute or chronic subdural hematoma will become the most common cranial neurosurgical condition among adults in 2030. 2 Steep increases in incidence rates of subdural hematoma among older patients (aged 75-89 years) were found in the present study. Furthermore, the present results emphasize that the major shifts in patterns of antithrombotic drug treatment for older individuals, 28 and the increasing use of more aggressive antithrombotic regimens, have already had a major effect on subdural hematoma incidence.…”

Section: Discussionsupporting

confidence: 59%

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confidence: 99%

“…2,3 Subacute or chronic subdural hematoma incidence is predicted to further increase due to the aging population. 2 Use of antithrombotic drugs has been associated with increased subacute or chronic subdural hematoma risk. In meta-analyses of controlled trials, use of a vitamin K antagonist (VKA) was associated with a pooled odds ratio (OR) of 3.0 for subacute or chronic subdural hematoma compared with antiplatelet therapy, and use of low-dose aspirin compared with no antithrombotic treatment was associated with a pooled OR of 1.6, which was not statistically significant.…”

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confidence: 99%

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Association of Antithrombotic Drug Use With Subdural Hematoma Risk

Garcı́a-Dorado

Rodrı́guez

Hellfritzsch

et al. 2017

JAMA

136

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Incidence of subdural hematoma has been reported to be increasing. To what extent this is related to increasing use of antithrombotic drugs is unknown.OBJECTIVES To estimate the association between use of antithrombotic drugs and subdural hematoma risk and determine trends in subdural hematoma incidence and antithrombotic drug use in the general population. DESIGN, SETTING, AND PARTICIPANTSCase-control study of 10 010 patients aged 20 to 89 years with a first-ever subdural hematoma principal discharge diagnosis from 2000 to 2015 matched by age, sex, and calendar year to 400 380 individuals from the general population (controls). Subdural hematoma incidence and antithrombotic drug use was identified using population-based regional data (population: 484 346) and national data (population: 5.2 million) from Denmark. Conditional logistic regression models were used to estimate odds ratios (ORs) that were adjusted for comorbidity, education level, and income level.EXPOSURES Use of low-dose aspirin, clopidogrel, a vitamin K antagonist (VKA), a direct oral anticoagulant, and combined antithrombotic drug treatment.MAIN OUTCOMES AND MEASURES Association of subdural hematoma with antithrombotic drug use, subdural hematoma incidence rate, and annual prevalence of treatment with antithrombotic drugs. RESULTS Among 10 010 patients with subdural hematoma (mean age, 69.2 years; 3462 women [34.6%]), 47.3% were taking antithrombotic medications. Current use of low-dose aspirin (cases: 26.7%, controls: 22.4%; adjusted OR, 1.24 [95% CI, 1.15-1.33]), clopidogrel (cases: 5.0%, controls: 2.2%; adjusted OR, 1.87 [95% CI, 1.57-2.24]), a direct oral anticoagulant (cases: 1.0%, controls: 0.6%; adjusted OR, 1.73 [95% CI, 1.31-2.28]), and a VKA (cases: 14.3%, controls: 4.9%; adjusted OR, 3.69 [95% CI, 3.38-4.03]) were associated with higher risk of subdural hematoma. The risk of subdural hematoma was highest when a VKA was used concurrently with an antiplatelet drug (low-dose aspirin and a VKA: 3.6% of cases and 1.1% of controls; adjusted OR, 4.00 [95% CI,; clopidogrel and a VKA: 0.3% of cases and 0.04% of controls; adjusted OR, 7.93 [95% CI, 4.49-14.02]). The prevalence of antithrombotic drug use increased from 31.0 per 1000 individuals from the general population in 2000 to 76.9 per 1000 individuals in 2015 (P < .001 for trend). The overall subdural hematoma incidence rate increased from 10.9 per 100 000 person-years in 2000 to 19.0 per 100 000 person-years in 2015 (P < .001 for trend). The largest increase was among older patients (>75 years; n = 4441) who experienced an increase from 55.1 per 100 000 person-years to 99.7 per 100 000 person-years (P < .001 for trend). CONCLUSIONS AND RELEVANCEIn Denmark, antithrombotic drug use was associated with higher risk of subdural hematoma; and the highest odds of subdural hematoma was associated with combined use of a VKA and an antiplatelet drug. The increased incidence of subdural hematoma from 2000 to 2015 appears to be associated with the increased use of antithrombotic drugs, particularly us...

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Section: Discussionsupporting

confidence: 59%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Association of Antithrombotic Drug Use With Subdural Hematoma Risk

Garcı́a-Dorado

Rodrı́guez

Hellfritzsch

et al. 2017

JAMA

136

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“…The incidence of CSDH is approximated between 8.2 to 14 persons per 100,000/year showing a trend towards an increase in the incidence of CSDH in the coming decades [1, 2]. CSDHs have several established predisposing risk factors such as advanced age, previous trauma to the head, anticoagulant and antiplatelet medication, and history of alcohol abuse contributing to global cerebral atrophy [1, 3]. …”

Section: Introductionmentioning

confidence: 99%

Does time from diagnostic CT until surgical evacuation affect outcome in patients with chronic subdural hematoma?

2018

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BackgroundChronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. Patients diagnosed with CSDH’s are often planned for subacute surgery. This means that time from diagnostic CT scan until actual surgery might often be prolonged. There are no previous studies that highlight the effect of delayed intervention in this population.MethodPatients that underwent surgical evacuation for a CSDH at Skåne University Hospital between 1 January 2015 and 31 December 2016 were included in this retrospective cohort study (n = 179). The primary aim was to determine if time from initial diagnosis by head-CT until surgical evacuation had a significant effect on outcome. The following was assessed by mortality, re-operation, number of days spent in hospital, discharge to home/institution, and functional outcome assessed by GOS. Secondary aims were to evaluate the effect of NOAC, vitamin K antagonists, and antiplatelet drugs on time from CT to surgery and re-operation frequency.ResultsMean time from diagnostic CT scan until surgery was 76 h. No significant relationship was found between time from CT to surgical evacuation and number of days spent in hospital, discharge to own home/institution, 1-year mortality, or outcome assessed by GOS at discharge from hospital. The clear majority (95.5%) of the patients were GCS ≥ 13 pre-operatively. No correlation could be seen between use of NOAC, vitamin K antagonists, or antiplatelet drugs regarding the risk for reoperation within 6 months, and no correlation between the use of these agents and time from CT to surgery. The 30-day mortality was too low to draw any statistically significant conclusions (n = 4).ConclusionIn this retrospective cohort study, we could conclude that a delay from initial diagnosis confirming a CSDH to surgical evacuation had no negative effect on outcome when surgery was performed within the time frames and on patients with pre-operatively favorable GCS scores (≥ 13) outlined in our study.

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“…Even though chronic SDH is one of the most common neurosurgical conditions, only a few studies have investigated its incidence in Caucasian populations in the era of modern brain imaging. The annual incidence has been found to be 8.2/100,000 in population over 65 years of age in North Wales [2] and estimated to be 16.8/100,000 among men 60-99 years of age in the United States [3]. We found that among patients with HD, the incidence rate was 68.3/100,000 person-years.…”

Section: Discussionmentioning

confidence: 87%