Mismatch between midline shift and hematoma thickness as a prognostic factor of mortality in patients sustaining acute subdural hematoma

Abstract

BackgroundAcute subdural hematoma (ASDH) is a traumatic lesion commonly found secondary to traumatic brain injury. Radiological findings on CT, such as hematoma thickness (HT) and structures midline shift (MLS), have an important prognostic role in this disease. The relationship between HT and MLS has been rarely studied in the literature. Thus, this study aimed to assess the prognostic accuracy of the difference between MLS and HT for acute outcomes in patients with ASDH in a low-income to middle-income country.MethodsThis was a post-hoc analysis of a prospective cohort study conducted in a university-associated tertiary-level hospital in Brazil. The TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis) statement guidelines were followed. The difference values between MLS and HT (Zumkeller index, ZI) were divided into three categories (<0.00, 0.01–3, and >3). Logistic regression analyses were performed to reveal the OR of categorized ZI in predicting primary outcome measures. A Cox regression was also performed and the results were presented through HR. The discriminative ability of three multivariate models including clinical and radiological variables (ZI, Rotterdam score, and Helsinki score) was demonstrated.ResultsA total of 114 patients were included. Logistic regression demonstrated an OR value equal to 8.12 for the ZI >3 category (OR 8.12, 95% CI 1.16 to 40.01; p=0.01), which proved to be an independent predictor of mortality in the adjusted model for surgical intervention, age, and Glasgow Coma Scale (GCS) score. Cox regression analysis demonstrated that this category was associated with 14-day survival (HR 2.92, 95% CI 1.38 to 6.16; p=0.005). A multivariate analysis performed for three models including age and GCS with categorized ZI or Helsinki or Rotterdam score demonstrated area under the receiver operating characteristic curve values of 0.745, 0.767, and 0.808, respectively.ConclusionsThe present study highlights the potential usefulness of the difference between MLS and HT as a prognostic variable in patients with ASDH.Level of evidenceLevel III, epidemiological study.

Prognostic Factors of Mortality and Functional Outcome for Acute Subdural Hematoma: A Review Article

“…Forty-two articles were excluded after the first round, and 18 more after reading of their full contents. 46 articles were eventually retained for qualitative analysis, 19 20 21 22 23 and 41 for quantitative analysis ( Fig. 1 ).…”

“…The usefulness of a Zumkeller index more than 3 mm for predicting mortality was further confirmed in univariate and multivariate analysis. 19 66 …”

A predictive model for awakening in patients with prolonged disorders of consciousness after craniocerebral injury

“…The midline brain structures include both neuronal efferent and afferent channels and the hypothalamic-pituitary axis and regulate heartbeat and respiration. [ 17 , 18 ] Therefore, minor damage to the midline brain structures can cause cardiac and respiratory abnormalities, and in severe cases, even arrest, and abnormalities in endocrine function. Compression damage to the brain tissue by intracranial hematoma can affect patients’ prognosis; thus, patients with shifted midbrain have more complications, severe conditions, difficult clinical recovery, and poorer prognosis.…”

Cerebral perfusion changes in acute subdural hematoma

“…The expected elevation of ICP in aSDH was observed in some studies and was often caused by brain swelling [ 18 ]. De Souza et al mentioned that brain swelling results in a disproportion between hematoma thickness and midline shift [ 6 ]. This study included 114 patients with aSDH.…”