Chronic subdural hematomas—causes of morbidity and mortality

Ramachandran, Ramnarayan; Hegde, Thimmappa

doi:10.1016/j.surneu.2006.07.022

Cited by 177 publications

(118 citation statements)

References 33 publications

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“…The in-hospital mortality rate of 16.7% modestly exceeds the reported range of 0-15.6%, 1,5,8,13,14,[16][17][18] but many of the more sanguine reports included children, 1,5,14,16 and with a mean age of 80 years, our population is the oldest cohort yet to be reported in the literature. The detrimental effect of diminished mental status at the time of admission on outcome has been previously noted by Gelabert-Gonzalez et al 5 and Rozzelle et al 18 The type of surgical intervention did not impact either the long-or short-term survival, as has also been noted by many authors.…”

Section: 21contrasting

confidence: 47%

“…Mori and Maeda 14 do specify their outcome measure at 1 month, whereas a host of other publications do not specify the follow-up interval at all, suggesting the analysis was restricted to the acute hospitalization period. 1,3,5,8,17,18 The sole outlier we could discover was Ramachandran and Hegde, 16 who indicate a 1-year follow-up that was accomplished in 94% of the cases. Their study of 647 cases includes all age groups but with only 31% (203 of 647) being older than age of 60 years, making comparisons with our elderly population tenuous.…”

Section: 21mentioning

confidence: 93%

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Chronic subdural hematoma in the elderly: not a benign disease

Miranda

Braxton²,

Hobbs³

et al. 2011

JNS

297

183

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Object Chronic subdural hematoma (CSDH) is perceived to be a “benign,” easily treated condition in the elderly, but reported follow-up periods are brief, usually limited to acute hospitalization. Methods The authors conducted a retrospective review of data obtained in a prospectively identified consecutive series of adult patients admitted to their institution between September 2000 and February 2008 and in whom there was a CT diagnosis of CSDH. Survival data were compared to life-table data. Results Of the 209 cases analyzed, 63% were men and the mean age was 80.6 years (range 65–96 years). Primary surgical interventions performed were bur holes in 21 patients, twist-drill closed-system drainage in 44, and craniotomies in 72. An additional 72 patients were simply observed. Reoperations were recorded in 5 patients—4 who had previously undergone twist-drill drainage and 1 who had previously undergone a bur hole procedure (p = 0.41, chi-square analysis). Thirty-five patients (16.7%) died in hospital, 130 were discharged to rehabilitation or a skilled care facility, and 44 returned home. The follow-up period extended to a maximum of 8.3 years (median 1.45 years). Six-month and 1-year mortality rates were 26.3% and 32%, respectively. In the multivariate analysis (step-wise logistic regression), the sole factor that predicted in-hospital death was neurological status on admission (OR 2.1, p = 0.02, for each step). Following discharge, the median survival in the remaining cohort was 4.4 years. In the Cox proportional hazards model, only age (hazard ratio [HR] 1.06/year, p = 0.02) and discharge to home (HR 0.24, p = 0.01) were related to survival, whereas the type of intervention, whether surgery was performed, size of subdural hematoma, amount of shift, bilateral subdural hematomas, and anticoagulant agent use did not affect the long- or short-term mortality rate. Comparison of postdischarge survival and anticipated actuarial survival demonstrated a markedly increased mortality rate in the CSDH group (median survival 4.4 vs 6 years, respectively; HR 1.94, p = 0.0002, log-rank test). This excess mortality rate was also observed at 6 months postdischarge with evidence of normalization only at 1 year. Conclusions In this first report of the long-term outcome of elderly patients with CSDH the authors observed persistent excess mortality up to 1 year beyond diagnosis. This belies the notion that CSDH is a benign disease and indicates it is a marker of other underlying chronic diseases similar to hip fracture.

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Section: 21contrasting

confidence: 47%

Section: 21mentioning

confidence: 93%

Chronic subdural hematoma in the elderly: not a benign disease

Miranda

Braxton²,

Hobbs³

et al. 2011

JNS

297

183

View full text Add to dashboard Cite

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“…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.…”

mentioning

confidence: 99%

Outcomes of chronic subdural hematoma drainage in nonagenarians and centenarians: a multicenter study

Lee

Ker

et al. 2016

JNS

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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...

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“…Semisolid clot was usually drained out or resolved within a few days with or without urokinase or tissue plasminogen activator. The surgery was usually effective, although the final outcome was dependent on the age, Glasgow Coma Score at presentation, and associated illnesses 11) .…”

Section: Discussionmentioning

confidence: 99%

Acute-on-Chronic Subdural Hematoma: Not Uncommon Events

Lee

Shim

Yoon

et al. 2011

J Korean Neurosurg Soc

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Objective : Patients with asymptomatic chronic subdural hematoma (SDH) are prone to fall or slip. Acute trauma on these patients may develop acute subdural bleeding over the chronic SDH. We recently experienced 9 patients with acute-on-chronic SDH. We report the clinical and radiological features of this lesion. Methods : We retrospectively examined the computed tomographic (CT) scans of 107 consecutive patients who diagnosed as chronic SDH from January 2008 to December 2010. All cases of CSDH were diagnosed on CT with or without MRI scan. Results : Acute-on-chronic SDH is not rare, being 8% of chronic SDH. The most common cause of trauma was a slip in drunken state. Alcoholism with multiple episodes of trauma was one of the prominent histories. Acute-on-chronic SDH appeared as a hyperdense layer of clot with irregular blurred margin or lumps in liquefied hematoma. Single or two burr holes was usually effective to remove the hematoma. Conclusion : Repeated trauma may cause acute bleeding over the chronic SDH. It will be helpful to understand the role of repeated trauma as a mechanism of hematoma enlargement.

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Chronic subdural hematomas—causes of morbidity and mortality

Cited by 177 publications

References 33 publications

Chronic subdural hematoma in the elderly: not a benign disease

Chronic subdural hematoma in the elderly: not a benign disease

Outcomes of chronic subdural hematoma drainage in nonagenarians and centenarians: a multicenter study

Acute-on-Chronic Subdural Hematoma: Not Uncommon Events

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