Risk Factors Predicting Recurrence of Bilateral Chronic Subdural Hematomas after Initial Bilateral Evacuation

Shen, Jun; Gao, Yalong; Li, Qifeng; Ge, Ruixiang; Wang, Qifu; Jiang, Xiaochun; Shao, Xinzhong

doi:10.1016/j.wneu.2019.06.016

Cited by 26 publications

(25 citation statements)

References 18 publications

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“…The controversy regarding the role of bilateral cSDH in the rate of recurrence may be confounded by the cSDH volume or brain atrophy. We did not find brain atrophy to be related to recurrence unlike Shen et al (16), but the measurement techniques were different. OACs increase the risk of cSDH 4-to 15-fold (17) depending on the intensity of anticoagulation, (17) patient's age (18); cerebral atrophy may also increase this risk.…”

Section: Discussioncontrasting

confidence: 78%

“…Similarly, Xu et al (15) showed that bilateral cSDH were not associated with recurrence; however, with 44 bilateral cases and 10 unilateral cases, the number of patients in that study was small. In contrast, Shen et al (16), reviewed 102 patients where bilateral cSDH was an independent risk factor for recurrence. The controversy regarding the role of bilateral cSDH in the rate of recurrence may be confounded by the cSDH volume or brain atrophy.…”

Section: Discussionmentioning

confidence: 99%

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Predicting Chronic Subdural Hematoma Recurrence and Stroke Outcomes While Withholding Antiplatelet and Anticoagulant Agents

et al. 2020

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The aging of the western population and the increased use of oral anticoagulation (OAC) and antiplatelet drugs (APD) will result in a clinical dilemma on how to balance the recurrence risk of chronic subdural hematoma (cSDH) with the risk of withholding blood thinners. Objective: To identify features that predicts recurrence, thromboembolism (TEE), hospital stay and mortality. To identify the optimal window for resuming APD or OAC. Methods: We performed a retrospective multivariate analysis of a prospectively collected database. We then build machine learning models for outcomes prediction. Results: We identified 596 patients. The rate of recurrence was 22.17%, that of thromboembolism was 0.9% and that of mortality was 14.78%. Smoking, platelet dysfunction, CKD, and alcohol use were independent predictors of higher recurrence, while resolution of the SDH was protective. OAC use had higher odds of developing TEEs. CKD, developing a new neurological deficit or a TEEs were independent predictors of higher mortality. We find the optimal time of resuming OAC to be after 2 days but before 21 days as these patients had the lowest recurrence of bleeding associated with a low risk of stroke. The ML model achieved an accuracy of 93, precision of 0.84 and recall of 0.80 for recurrence prediction. ML models for hospital stay performed poorly (R 2 = 0.33). ML model for stroke was overfitted given the low number of events. Conclusion: ML modeling is feasible. However, large well-designed prospective multicenter studies are needed for accurate ML so that clinicians can balance the risks of recurrence with the risk of TEEs, especially for high-risk anticoagulated patients.

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Section: Discussioncontrasting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Predicting Chronic Subdural Hematoma Recurrence and Stroke Outcomes While Withholding Antiplatelet and Anticoagulant Agents

et al. 2020

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“…The recurrence rate in unilateral CSDH is lower than that of bilateral CSDH, making bilateral hematoma a risk factor for CSDH recurrence [16,19]. This could be due to poor brain re-expansion in bilateral CSDH compared to unilateral CSDH, which may result in a brain parenchymal shift, tearing of the blood vessels, postoperative pneumocephalus and cerebrospinal fluid accumulation in the hematoma cavity, leading to a higher recurrence rate [19,34,35]. Another theory is that patients with bilateral CSDH tend to have a history of brain atrophy, which leads to poor re-expansion, resulting in a higher recurrence rate [19,35].…”

Section: Discussionmentioning

confidence: 99%

“…This could be due to poor brain re-expansion in bilateral CSDH compared to unilateral CSDH, which may result in a brain parenchymal shift, tearing of the blood vessels, postoperative pneumocephalus and cerebrospinal fluid accumulation in the hematoma cavity, leading to a higher recurrence rate [19,34,35]. Another theory is that patients with bilateral CSDH tend to have a history of brain atrophy, which leads to poor re-expansion, resulting in a higher recurrence rate [19,35]. In our study, bilateral hematoma was found to be a risk factor for postoperative recurrence of CSDH, but was not a risk factor for postoperative AIH.…”

Section: Discussionmentioning

confidence: 99%

Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

Chen

Wang

et al. 2020

BMC Neurol

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Background: To investigate predictors of postoperative acute intracranial hemorrhage (AIH) and recurrence of chronic subdural hematoma (CSDH) after burr hole drainage. Methods: A multicenter retrospective study of patients who underwent burr hole drainage for CSDH between January 2013 and March 2019. Results: A total of 448 CSDH patients were enrolled in the study. CSDH recurrence occurred in 60 patients, with a recurrence rate of 13.4%. The mean time interval between initial burr hole drainage and recurrence was 40.8 ± 28.3 days. Postoperative AIH developed in 23 patients, with an incidence of 5.1%. The mean time interval between initial burr hole drainage and postoperative AIH was 4.7 ± 2.9 days. Bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independent predictors of recurrence in the multiple logistic regression analyses. Preoperative headache was an independent risk factor of postoperative AIH in the multiple logistic regression analyses, however, intraoperative irrigation reduced the incidence of postoperative AIH. Conclusions: This study found that bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independently associated with CSDH recurrence. Clinical presentation of headache was the strongest predictor of postoperative AIH, and intraoperative irrigation decreased the incidence of postoperative AIH.

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“…[16, 19] This could be due to poor brain re-expansion in bilateral CSDH compared to unilateral CSDH, which may result in a brain parenchymal shift, tearing of the blood vessels, postoperative pneumocephalus and cerebrospinal fluid accumulation in the hematoma cavity, leading to a higher recurrence rate. [19,34,35] Another theory is that patients with bilateral CSDH tend to have a history of brain atrophy, which leads to poor re-expansion, resulting in a higher recurrence rate. [19,35] In our study, bilateral hematoma was found to be a risk factor for postoperative recurrence of CSDH, but was not a risk factor for postoperative AIH.…”

mentioning

confidence: 99%

Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

Chen

Wang

et al. 2020

Preprint

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Background To investigate predictors of postoperative acute intracranial hemorrhage (AIH) and recurrence of chronic subdural hematoma (CSDH) after burr hole drainage. Methods A multicenter retrospective study of patients who underwent burr hole drainage for CSDH between January 2013 and March 2019. Results A total of 448 CSDH patients were enrolled in the study. CSDH recurrence occurred in 60 patients, with a recurrence rate of 13.4%. The mean time interval between initial burr hole drainage and recurrence was 40.8±28.3 days. Postoperative AIH developed in 23 patients, with an incidence of 5.1%. The mean time interval between initial burr hole drainage and postoperative AIH was 4.7±2.9 days. Bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independent predictors of recurrence in the multiple logistic regression analyses. Preoperative headache was an independent risk factor of postoperative AIH in the multiple logistic regression analyses, however, intraoperative irrigation reduced the incidence of postoperative AIH. Conclusions This study found that bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independently associated with CSDH recurrence. Clinical presentation of headache was the strongest predictor of postoperative AIH, and intraoperative irrigation decreased the incidence of postoperative AIH.

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Risk Factors Predicting Recurrence of Bilateral Chronic Subdural Hematomas after Initial Bilateral Evacuation

Cited by 26 publications

References 18 publications

Predicting Chronic Subdural Hematoma Recurrence and Stroke Outcomes While Withholding Antiplatelet and Anticoagulant Agents

Predicting Chronic Subdural Hematoma Recurrence and Stroke Outcomes While Withholding Antiplatelet and Anticoagulant Agents

Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

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