The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom

Brennan, Paul M.; Kolias, Angelos G.; Joannides, Alexis; Shapey, Jonathan; Marcus, Hani J.; Gregson, Barbara; Grover, Patrick; Hutchinson, Peter J.; Coulter, Ian C.

doi:10.3171/2016.8.jns16134.test

Cited by 48 publications

(91 citation statements)

References 25 publications

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“…Multiple comorbidities, reduced physiological reserve, worse pre-morbid functional status, and the natural increased risk of death in very elderly people are all factors that are likely to contribute towards this. We also found that increasing age does not appear to be associated with increased recurrence risk, consistent with previous studies [9,12,[16][17][18][19][20].…”

Section: Discussionsupporting

confidence: 92%

“…The detailed study protocol for the prospective multicentre study has been published previously [9,11]. Briefly, this was a prospective multicentre cohort study in the UK and Ireland that aimed to describe the perioperative clinical characteristics and short-term outcomes of patients with CSDH.…”

Section: Methodsmentioning

confidence: 99%

“…Second is a relative functional improvement comparing the mRS on discharge with the pre-operative mRS. This measure was defined post hoc and was not included in the original protocol [9,11]. Mortality was defined as death due to any cause that occurred during admission in the NSU.…”

Section: Outcome Measuresmentioning

confidence: 99%

“…Whilst the median age of patients admitted to neurosurgical units (NSUs) for surgery is 77 [9], no consensus currently exists in the management of very elderly patients with CSDH (≥ 90 years old). Surgery may hence be delayed or refused, because of the increased risk of perioperative morbidity and mortality and the perception of an expected likelihood Edward Christopher and Michael T. C. Poon contributed equally to this work.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma

Christopher

Poon²,

Glancz

et al. 2018

Neurosurg Rev

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Increasing age and lower pre-operative Glasgow coma score (GCS) are associated with worse outcome after surgery for chronic subdural haematoma (CSDH). Only few studies have quantified outcomes specific to the very elderly or comatose patients. We aim to examine surgical outcomes in these patient groups. We analysed data from a prospective multicentre cohort study, assessing the risk of recurrence, death, and unfavourable functional outcome of very elderly (≥ 90 years) patients and comatose (pre-operative GCS ≤ 8) patients following surgical treatment of CSDH. Seven hundred eighty-five patients were included in the study. Thirty-two (4.1%) patients had pre-operative GCS ≤ 8 and 70 (8.9%) patients were aged ≥ 90 years. A higher proportion of comatose patients had an unfavourable functional outcome (38.7 vs 21.7%; p = 0.03), although similar proportion of comatose (64.5%) and noncomatose patients (61.8%) functionally improved after surgery (p = 0.96). Compared to patients aged < 90 years, a higher proportion of patients aged ≥ 90 years had unfavourable functional outcome (41.2 vs 20.5%; p < 0.01), although approximately half had functional improvement following surgery. Mortality risk was higher in both comatose (6.3 vs 1.9%; p = 0.05) and very elderly (8.8 vs 1.1%; p < 0.01) groups. There was a trend towards a higher recurrence risk in the comatose group (19.4 vs 9.5%; p = 0.07). Surgery can still provide considerable benefit to very elderly and comatose patients despite their higher risk of morbidity and mortality. Further research would be needed to better identify those most likely to benefit from surgery in these groups.

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Section: Discussionsupporting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Section: Outcome Measuresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma

Christopher

Poon²,

Glancz

et al. 2018

Neurosurg Rev

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“…The project was driven by trainees and supported by consultants in all participating units [2]. The study found that a subdural drain was used in 85% of patients, while according to the 2006 survey 85% surgeons in the UK and the Republic of Ireland would either never use or use drains in less than a quarter of burr hole drainage operations [11]; this confirms the substantial uptake of the Cambridge CSDH trial findings across the UK [1]. Additionally, the study established that the UK-wide recurrence rate was 9%, which is very similar to the recurrence rate observed in the drain arm of the Cambridge CSDH trial.…”

supporting

confidence: 64%

Chronic subdural haematoma: disseminating and implementing best practice

2017

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Rates of Repeated Operation for Isolated Subdural Hematoma Among Older Adults

et al. 2018

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Key Points Question What is the rate of repeated operation for isolated subdural hematoma? Findings In this study of 2 cohorts from the National Surgical Quality Improvement Project registry and Medicare beneficiaries, 515 patients older than 65 years and 1534 Medicare beneficiaries underwent surgical evacuation of an isolated subdural hematoma. Of these patients, approximately 5% to 10% required repeated operation within 30 to 90 days. Meaning These results highlight the need for prospective studies and clinical trials on better methods to prevent isolated subdural hematoma recurrence and may help practitioners across a variety of disciplines calibrate their index of suspicion to ensure that patients are referred for timely surgical care.

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The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom

Cited by 48 publications

References 25 publications

Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma

Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma

Chronic subdural haematoma: disseminating and implementing best practice

Rates of Repeated Operation for Isolated Subdural Hematoma Among Older Adults

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