The epidemiology, risk factors, and impact on hospital mortality of status epilepticus after subdural hematoma in the United States

Seifi, Ali; Asadi‐Pooya, Ali A.; Carr, Kevin; Maltenfort, Mitchell; Emami, Mehrdad; Bell, Rodney; Moussouttas, Michael; Yazbeck, Moussa; Rincón, Fred

doi:10.1186/2193-1801-3-332

Cited by 26 publications

(26 citation statements)

References 56 publications

(94 reference statements)

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“…A large epidemiological study reported major organ dysfunction as an independent predictor of mortality. 1,24 Our results showed that the short-term prognosis (acute phase) in elderly patients depends not on comorbidities but on the severity of aSDH, which is expressed by pupillary abnormalities or unconsciousness. 7 Nonetheless, long-term prognosis (3 months' follow-up) in survivors of aSDH also depends on the cumulating comorbidities.…”

Section: Discussionmentioning

confidence: 94%

“…Previous studies of TBI in patients over 65 years of age have shown that age and GCS score are independent predictors of an unfavorable outcome. 24,27 Indeed, all patients with severe TBI were dependent in daily living activities 6 months after injury, and the mortality rate was 24 times higher than that in patients with a good GCS score. 27 Similarly, the severity of aSDH, as part of TBI, has been reported to be an independent predictor of poor prognosis in several studies observing a younger cohort of patients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Significant increase in acute subdural hematoma in octo- and nonagenarians: surgical treatment, functional outcome, and predictors in this patient cohort

Won¹,

Dubinski²,

Brawanski³

et al. 2017

Neurosurgical Focus

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OBJECTIVEAcute subdural hematoma (aSDH) is a common disease increasing in prevalence given the demographic growth of the aging population. Yet, the benefit of surgical treatment for aSDH and the subsequent functional outcome in elderly patients (age ≥ 80 years) remain unclear. Therefore, the aims of this study were to evaluate the incidence of aSDH in patients 80 years or older, determine overall functional outcome, identify predictors of an unfavorable or favorable outcome, and establish specific risk factors for seizures.METHODSThe authors retrospectively analyzed patients 80 years and older who presented with isolated aSDH in the past 10 years at their institution. The following parameters were assessed: baseline characteristics, clinical status on admission and 24 hours after surgery, and clinical course. Functional outcome was assessed at discharge and the 3-month follow-up (FU).RESULTSIn the period from January 2007 to December 2016, 165 patients with aSDH were admitted to the authors’ institution. Sixty-eight patients (41.2%) were 80 years old or older, and the mean age overall was 85 years (range 80–96 years). The incidence of aSDH in the elderly had significantly increased over past decade, with more than 50% of patients admitted to our institution for aSDH now being 80 years or older. The overall mortality rate was 28% at discharge and 48% at the FU. Independent predictors of an unfavorable outcome at discharge were a GCS score ≤ 8 at 24 hours after operation (p < 0.001) and pneumonia (p < 0.02). At the FU, a GCS score ≤ 8 at 24 hours after operation (p < 0.001) and cumulative comorbidities (≥ 5; p < 0.05) were significant independent predictors. All patients with more than 6 comorbidities had died by the FU. Surgical treatment in comatose compared to noncomatose patients had statistically significant, higher mortality rates at discharge and the FU. Still, 23% of the comatose patients and more than 50% of the noncomatose patients had a favorable outcome at the FU (p = 0.06).CONCLUSIONSThe number of octo- and nonagenarians with aSDH significantly increased over the last decade. These patients can achieve a favorable outcome, especially those with a noncomatose status and fewer than 5 comorbidities. Surgical and nonsurgical treatment of octo- and nonagenarians during and after discharge should be optimized to increase clinical improvement.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Significant increase in acute subdural hematoma in octo- and nonagenarians: surgical treatment, functional outcome, and predictors in this patient cohort

Won¹,

Dubinski²,

Brawanski³

et al. 2017

Neurosurgical Focus

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“…The data showed increase statistical important in incidence of hospitalizations for SDH, from 13 per 100,000 inhabitants in 1988 to 38 per 100,000 inhabitants in 2011; we observed a concomitant increase in the prevalence of status epilepticus associated with SDH, from 0.5% in 1988 to 0.7% in 2011 [12].…”

mentioning

confidence: 62%

Traumatic brain injury (TBI): morbidity, mortality and economic implications

Souza¹,

Pinheiro²,

Silva³

et al. 2015

Int Arch Med

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Traumatisms, in general, result in high costs for health systems worldwide. They consist of the leading cause of death in young adults, primarily males. Traumatic brain injury (TBI) represents good part of this spending, reaching globally significant mortality rate, around 1.5 million victims a year. Only in the United States (US) attendances related to traumatic brain injuries in emergency departments revolve around 1.35 million annually, plus about 275,000 hospitalizations and 52,000 deaths. In Brazil, only in 2012 was spent over one billion dollars with hospitalizations related to external causes, including TBI. Mild TBI (Glasgow Coma Scale (GCS) 14-15) occur in about 80% of the total demand, moderate (GCS 9-13) in 10% and serious (GCS 3-8) in 10 %. Regarding mortality rate, this is relatively low compared to the total number, since much of fatal outcomes fits in the moderate to severe groups. One of lesions a valuable prognostic factor related to the TBI is the subdural hematoma (SDH), responsible for complications in up to 45% of cases of TBI, expressing mortality between 60-80% depending on the implemented workup and may even reach 90% when in delay of appropriate treatment. The acute subdural hematoma (ASDH) thus represents a neurosurgical emergency, taking most of these patients to be subjected to urgent evacuation of the hematoma by craniotomy, which also is not without risks, with several reports in literature of new contralateral hematoma formation after craniotomy for evacuation of hematoma, further aggravating the patient's prognosis. For best results of the TBI is needed better understanding of the pathophysiology, identification of newer parameters of brain function and development of innovative therapeutic modalities. According to the Centers for Disease Control and Prevention (CDC), under the Department of Health and Human Services, population data on TBI are fundamental for understanding its impact on the society and know the profile of patients and the mechanisms trauma, to assist in the formulation of prevention strategies and in setting priorities for research and support services to patients living with traumatic brain injury.

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“…11,13,14 The reported incidence of seizures in cSDH varies in between 2% and 42%, and some predictors, such as alcoholism, male sex, low Glasgow Coma Scale (GCS) at admission, previous stroke, and hematoma density, were identified in a smaller number of patients. 24,25 Indeed, there are further questions remaining as to with which prognosis and perspective we should be alerted and treat the patients with cSDH-associated ASz. 9,[14][15][16][17][18][19][20][21][22][23] Furthermore, the significance of status epilepticus (SE) in cSDH, which is associated with even higher morbidity and mortality, is not well studied.…”

Section: Introductionmentioning

confidence: 99%

“…23 However, concerning that, presumably, most of the studies dealt with acute symptomatic seizures, we observed a similar incidence of ASz/SE of 17%. B, Subgroup analysis of outcome assessed via mRS in patients with acute symptomatic seizure (ASz) and status epilepticus (SE) index of suspicion 24. The authors described the possibility of initial underdiagnosis of SE due to low F I G U R E 2 A, Outcome assessed via modified Rankin scale (mRS) in chronic subdural hematoma with acute symptomatic seizures (ASz/ SE) and no seizure at hospital discharge.…”

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confidence: 99%

Seizure and status epilepticus in chronic subdural hematoma

et al. 2019

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Background: Acute symptomatic seizure (ASz) and status epilepticus (SE) are serious conditions associated with poor quality of life, with unfavorable psychosocial and functional outcome. Chronic subdural hematoma (cSDH) is a common neurosurgical disease related to those complications; therefore, we aimed to evaluate incidence, predictors of ASz/SE, and outcome in this cohort. Methods:We retrospectively analyzed patient diagnosed cSDH between 2010 and 2017. Beside their incidence of ASz/SE, patient characteristics, symptoms at admission, comorbidities, and all previously published relevant parameters were assessed.Recurrence rate and functional outcome were analyzed at hospital discharge and 90-day follow-up.Results: A total of 375 patients were included; incidence of ASz was 15.2% and of SE, 1.9%. In the univariate analysis, drainage insertion (P = 0.004; OR = 0.3) was a significant negative predictor for ASz/SE and multivariate analysis, including all significant parameters, designated GCS ≤13 at admission (P = 0.09; OR = 1.9), remote stroke (P = 0.009; OR = 2.9), and recurrence rate within 14 days (P = 0.001; OR = 3.3;with an incidence of 13%) as independent predictors for ASz/SE. Overall, patients with ASz/SE had significantly unfavorable outcome at discharge (54.7%; P < 0.001) and follow-up (39.5%; P < 0.001) with only slight improvement. Late seizures occurred in 3.8% within follow-up period. Any patient with SE had an unfavorable outcome at discharge without any improvement at follow-up having a mortality rate of 14.2%.Conclusion: Independent predictors for ASz/SE are GCS ≤13 at admission, remote stroke, and recurrent hematoma in patients with cSDH, which is associated with worse functional outcome, particularly those with SE. Due to the higher rate of seizures than recurrence rate, a routine pre-and postoperative EEG besides CT is recommended. K E Y W O R D Schronic subdural hematoma, EEG, functional outcome, predictors, seizures, status epilepticus | 195 WON et al.

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The epidemiology, risk factors, and impact on hospital mortality of status epilepticus after subdural hematoma in the United States

Cited by 26 publications

References 56 publications

Significant increase in acute subdural hematoma in octo- and nonagenarians: surgical treatment, functional outcome, and predictors in this patient cohort

Significant increase in acute subdural hematoma in octo- and nonagenarians: surgical treatment, functional outcome, and predictors in this patient cohort

Traumatic brain injury (TBI): morbidity, mortality and economic implications

Seizure and status epilepticus in chronic subdural hematoma

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