Prognostic Scoring for Chronic Subdural Hematoma: Is Decision Making Easier?

Commentary

“…In fact, in a not negligible rate of cases, the final clinical status is far from the desirable, with a substantial regression of quality of life. [6][7][8] We agree with many studies that the comorbidities of patients, their initial clinical conditions, and the radiological features of the hematoma are relevant prognostic factors, which should be considered to predict the final patient's outcome. [6][7][8] Revising our surgical experience on 216 CSDH cases operated between 2013 and 2015, we found that patients older than 81 (hazard ratio [HR]: 6.16 e P < 0.0001), with cardiological comorbidities (HR: 1.88 e P = 0.04.…”

“…[6][7][8] We agree with many studies that the comorbidities of patients, their initial clinical conditions, and the radiological features of the hematoma are relevant prognostic factors, which should be considered to predict the final patient's outcome. [6][7][8] Revising our surgical experience on 216 CSDH cases operated between 2013 and 2015, we found that patients older than 81 (hazard ratio [HR]: 6.16 e P < 0.0001), with cardiological comorbidities (HR: 1.88 e P = 0.04. ), or chronic pneumatics (HR: 2.43, P = 0.003), or preoperative dementia (HR: 2.04, P = 0.03) or worse neurological condition at surgery, evaluated basing on the Glasgow Coma Scale (HR: 2.04, P = 0.03), presented a shorter survival time at a multivariate statistical analysis despite the resolution of CSDH on postoperative scans.…”

“…In 2017, 191 papers were reported in the medical literature on this topic, and in the first 9 months of 2018, of patients with CSDH is only partially dependent on the technical issue, it is, also, due to the patient's clinical condition, comorbidities, and medical therapies. [7,8] To some extent, we face the paradoxical scenario that one of the less technical demanding neurosurgical maneuver, usually quick, with low complication, and even not always requiring general anesthesia, could lead to scarcely acceptable results. Indeed, if we accept that CSDH manifests as a reversible form of dementia, the aim of any treatment should be the restoring of the patients' previous quality of life, independence in daily activities, and general performance.…”

External validation of prognostic models predicting outcome after chronic subdural hematoma

“…Over the years, several CSDH prognostic models [ 1 , 3 , 5 , 10 – 12 , 16 , 20 , 22 , 23 , 25 , 27 , 30 , 31 , 34 , 37 , 38 , 40 , 42 , 46 , 48 , 54 – 58 ] have been published. The developers of CSDH prognostic models aim to predict and stratify patients’ risk of mortality, recurrence, and/or functional outcome after surgical CSDH treatment.…”