Chronic subdural hematoma: Surgical management and outcome in 986 cases: A classification and regression tree approach

Rovlias, A.; Theodoropoulos, Spyridon; Dimitrios, Papoutsakis

doi:10.4103/2152-7806.161788

Cited by 70 publications

(55 citation statements)

References 58 publications

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“…Additionally, a multivariate analysis was carried out to evaluate the relationship between frailty and outcomes by adjusting for age; CFS, CCI, CONUT scores; and recurrence. Subsequently, we used the area under the receiver operating characteristic curve to compare the accuracy between the model with seven known clinical predictors (age, Glasgow Coma Scale, dementia, midline shift, hematoma thickness, and presence of motor deficit and disorientation on admission) and with six values examined in the present study (age, CFS, dementia, CCI score, CONUT score and recurrence). All statistical analyses were carried out with EZR (Saitama Medical Center, Jichi Medical University, Saitama, Japan), which is a graphical user interface for R (The R Foundation for Statistical Computing, Vienna, Austria).…”

Section: Methodsmentioning

confidence: 99%

“…Chronic subdural hematoma (CSDH) is one of the most common diseases encountered by healthcare professionals in the field of neurosurgery. In general, CSDH patients are considered to have a good prognosis; however, this presumption does not necessarily apply to all patients, especially among older individuals . Older people with CSDH are likely to have low functional status and poor prognosis.…”

Section: Introductionmentioning

confidence: 99%

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Importance of frailty evaluation in the prediction of the prognosis of patients with chronic subdural hematoma

Shimizu

Sadatomo

Hara

et al. 2018

Geriatrics Gerontology Int

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Chronic subdural hematoma patients with frailty had a poorer prognosis than those without (median modified Rankin Scale: 4 and 2, P < 0.001; proportions of patients discharged to home: 35% and 91%, P < 0.001, respectively). After adjusting for patients' background, the patients' modified Rankin Scale scores at 3 months after surgery were found to be associated with age, controlling nutritional status score and recurrence, but not with frailty. However, receiver operating characteristic curves of the model with the Clinical Frailty Scale were more accurately correlated with prognosis than those of the model without this scale (area under the curve 0.98, 95% confidence interval 0.96-0.99; and 0.87, 95% confidence interval 0.82-0.91, respectively.) CONCLUSIONS: Chronic subdural hematoma patients with frailty had poorer prognosis than those without. The evaluation of the presence of frailty on admission can be an important factor in the prediction of the prognosis of chronic subdural hematoma patients. Geriatr Gerontol Int 2018; 18: 1173-1176.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Importance of frailty evaluation in the prediction of the prognosis of patients with chronic subdural hematoma

Shimizu

Sadatomo

Hara

et al. 2018

Geriatrics Gerontology Int

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“…Since brain atrophy can be difficult to measure, we chose to use previously diagnosed dementia as a marker instead [6]. Previous diagnosis of either Alzheimer’s disease, vascular dementia, Lewy body dementia, or frontotemporal dementia in our cohort was registered as dementia.…”

Section: Methodsmentioning

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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“…The results of the prognostic factors for PFS and OS in the multivariate analysis are summarized in Tables II and III. Classification tree model. Based on the clinical data, a classification and regression tree method (13,14), a non-parametric regression method, was used. In addition, the method selected the automatic depth, which was length of the classification tree model.…”

Section: Survival Analysismentioning

confidence: 99%

Prognostic factors analysis in EGFR mutation-positive non-small cell lung cancer with brain metastases treated with whole brain-radiotherapy and EGFR-tyrosine kinase inhibitors

Wei

Lin

et al. 2016

Oncology Letters

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Abstract. The survival time of non-small cell lung cancer (NSCLC) patients with brain metastases has been previously reported to be 6.5-10.0 months, even with systematic treatment. Patients that possess a certain epidermal growth factor receptor (EGFR) mutation alongside NSCLC with brain metastases also have a short survival rate, and a reliable prognostic model for these patients demonstrates a strong correlation between the outcome and treatment recommendations. The Cox proportional hazards regression and classification tree models were used to explore the prognostic factors in EGFR mutation-positive NSCLC patients with brain metastases following whole-brain radiation therapy (WBRT) and EGFR-tyrosine kinase inhibitor (EGFR-TKI) treatment. A total of 66 EGFR mutation-positive NSCLC patients with brain metastases were retrospectively reviewed. Univariate and multivariate analyses by Cox proportional hazards regression were then performed. The classification tree model was applied in order to identify prognostic groups of the patients. In the survival analysis, age, carcinoembryonic antigen (CEA) and status of the primary tumor were prognostic factors for progression free survival (P=0.006, 0.014 and 0.005, respectively) and overall survival (P= 0.009, 0.013 and 0.009, respectively). The classification tree model was subsequently applied, which revealed 3 patient groups with significantly different survival times: Group I, age <65 years and CEA ≤10 µg/ml; Group II, age <65 years and CEA >10 µg/ml or age ≥65 years and CEA ≤10 µg/ml; and Group III, age ≥65 years and CEA >10 µg/ml. The major prognostic predictors for EGFR mutation-positive NSCLC patients with brain metastases following WBRT and EGFR-TKI were age and CEA. In addition, primary tumor control may be important for predicting survival. IntroductionPatients with non-small cell lung cancer (NSCLC) possess a high risk of developing brain metastases. The incidence rate of brain metastases for patients with lung cancer is 23-65% (1). Once intracerebral metastases develop, the prognosis is poor. The median survival time for patients with untreated brain metastases is only ~1 month (2,3). The principle therapeutic modality for brain metastases is whole-brain radiation therapy (WBRT), and the median survival time following this treatment may increase to 4-6 months. Although therapies, including surgery, WBRT, stereotactic radiotherapy and systematic chemotherapy, are rapidly improving, the prognosis of patients with brain metastases from lung cancer remains poor, and the median survival time for patients remains at ~6.5-10 months (4-7).In 2004, the genes encoding the read code box of epidermal growth factor receptor (EGFR) were sequenced (8). In addition, the gene mutation status has been elucidated and is now widely used in clinical practice. As a result, the identification of the EGFR mutation and the introduction of treatment with EGFR-tyrosine kinase inhibitors (EGFR-TKI) has improved clinical outcomes (9). EGFR-TKI regimens have a good efficacy against brain...

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Chronic subdural hematoma: Surgical management and outcome in 986 cases: A classification and regression tree approach

Cited by 70 publications

References 58 publications

Importance of frailty evaluation in the prediction of the prognosis of patients with chronic subdural hematoma

Importance of frailty evaluation in the prediction of the prognosis of patients with chronic subdural hematoma

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

Prognostic factors analysis in EGFR mutation-positive non-small cell lung cancer with brain metastases treated with whole brain-radiotherapy and EGFR-tyrosine kinase inhibitors

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