Unfavorable functional outcome is expected for elderly patients suffering from acute subdural hematoma even when presenting with preserved level of consciousness

Sufaro, Yuval; Avraham, Elad; Alguyn, Farouq; Azriel, Amit; Melamed, Israel

doi:10.1016/j.jocn.2019.05.015

Cited by 7 publications

(11 citation statements)

References 19 publications

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“…More importantly, differences in surgical timing may reflect different clinical severities. 10,24 In our series, there was a range of timings for surgical treatment, going from less than 6 hours to 3 days after admission. This has been influenced by those patients who had a deterioration in their GCS score, the development or worsening of neurological deficits, or the worsening of radiological findings after initial assessment.…”

Section: Role Of Surgerymentioning

confidence: 87%

“…8 Besides death, a vegetative state or severe residual disability has often been reported in these patients, all regarded as poor outcomes. 2,9,10 Even with an awareness of these adverse events, some factors such as family pressure, medico-legal aspects, and intradepartmental reputation could influence whether an aggressive surgical approach is followed despite the expectation of a poor outcome. 11 Among the outcome predictors, level of consciousness according to the Glasgow Coma Scale (GCS) score, ASDH thickness, and amount of midline shift have been recognized as the most important, 2,6,7,[12][13][14] while the role of antithrombotic therapy 15,16 and the presence of comorbidities 17,18 remain controversial.…”

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confidence: 99%

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Acute subdural hematoma in the elderly: outcome analysis in a retrospective multicentric series of 213 patients

Trevisi

Sturiale

Scerrati

et al. 2020

Neurosurgical Focus

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OBJECTIVEThe objective of this study was to analyze the risk factors associated with the outcome of acute subdural hematoma (ASDH) in elderly patients treated either surgically or nonsurgically.METHODSThe authors performed a retrospective multicentric analysis of clinical and radiological data on patients aged ≥ 70 years who had been consecutively admitted to the neurosurgical department of 5 Italian hospitals for the management of posttraumatic ASDH in a 3-year period. Outcome was measured according to the Glasgow Outcome Scale (GOS) at discharge and at 6 months’ follow-up. A GOS score of 1–3 was defined as a poor outcome and a GOS score of 4–5 as a good outcome. Univariate and multivariate statistics were used to determine outcome predictors in the entire study population and in the surgical group.RESULTSOverall, 213 patients were admitted during the 3-year study period. Outcome was poor in 135 (63%) patients, as 65 (31%) died during their admission, 33 (15%) were in a vegetative state, and 37 (17%) had severe disability at discharge. Surgical patients had worse clinical and radiological findings on arrival or during their admission than the patients undergoing conservative treatment. Surgery was performed in 147 (69%) patients, and 114 (78%) of them had a poor outcome. In stratifying patients by their Glasgow Coma Scale (GCS) score, the authors found that surgery reduced mortality but not the frequency of a poor outcome in the patients with a moderate to severe GCS score. The GCS score and midline shift were the most significant predictors of outcome. Antiplatelet drugs were associated with better outcomes; however, patients taking such medications had a better GCS score and better radiological findings, which could have influenced the former finding. Patients with fixed pupils never had a good outcome. Age and Charlson Comorbidity Index were not associated with outcome.CONCLUSIONSTraumatic ASDH in the elderly is a severe condition, with the GCS score and midline shift the stronger outcome predictors, while age per se and comorbidities were not associated with outcome. Antithrombotic drugs do not seem to negatively influence pretreatment status or posttreatment outcome. Surgery was performed in patients with a worse clinical and radiological status, reducing the rate of death but not the frequency of a poor outcome.

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Section: Role Of Surgerymentioning

confidence: 87%

mentioning

confidence: 99%

Acute subdural hematoma in the elderly: outcome analysis in a retrospective multicentric series of 213 patients

Trevisi

Sturiale

Scerrati

et al. 2020

Neurosurgical Focus

View full text Add to dashboard Cite

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“…Mean duration of follow-up in studies included for meta-analysis was 6.4 months (range 2–12 months) ( table 2 ). One study 37 reported modified Rankin Scale (mRS) scores at discharge and LTFU. Poor outcome was defined as mRS 5–6, and reported in 28% (8/28 patients) at discharge and 57% (16/28 patients) at LTFU.…”

Section: Resultsmentioning

confidence: 99%

Acute subdural haematoma in the elderly: to operate or not to operate? A systematic review and meta-analysis of outcomes following surgery

Manivannan¹,

Spencer

Marei

et al. 2021

BMJ Open

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ObjectivesAcute subdural haematoma (ASDH) is a devastating pathology commonly found on CT brain scans of patients with traumatic brain injury. The role of surgical intervention in the elderly has been increasingly questioned due to its associated morbidity and mortality. Therefore, a systematic review and meta-analysis of the literature to quantify the mortality and functional outcomes associated with surgical management of ASDH in the elderly was performed.Design/settingA multidatabase literature search between January 1990 and May 2020, and meta-analysis of proportions was performed to quantify mortality and unfavourable outcome (Glasgow Outcome scale 1–3; death/ severe disability) rates.ParticipantsStudies reporting patients aged 60 years or older.InterventionsCraniotomy, decompressive craniectomy, conservative management.Outcome measuresMortality and functional outcomes (discharge, long-term follow-up (LTFU)).Results2572 articles were screened, yielding 21 studies for final inclusion and 15 for meta-analysis. Pooled estimates of mortality were 39.83% (95% CI 32.73% to 47.14%; 10 studies, 308/739 patients, I2=73%) at discharge and 49.30% (95% CI 42.01% to 56.61%; 10 studies, 277/555 patients, I2=63%) at LTFU. Mean duration of follow-up was 7.1 months (range 2–12 months). Pooled estimate of percentage of poor outcomes was 81.18% (95% CI 75.61% to 86.21%; 6 studies, 363/451 patients, I2=45%) at discharge, and 79.25% (95% CI 72.42% to 85.37%; 8 studies, 402/511 patients, I2=66%) at LTFU. Mean duration of follow-up was 6.4 months (range 2–12 months). Potential risk factors for poor outcome included age, baseline functional status, preoperative neurological status and imaging parameters.ConclusionsOutcomes following surgical evacuation of ASDH in patients aged 60 years and above are poor. This constitutes the best level of evidence in the current literature that surgical intervention for ASDH in the elderly carries significant risks, which must be weighed against benefits.PROSPERO registration numberCRD42020189508.

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“…As many specialists will attest, there is rarely an adequate algorithmic approach, despite guidance from the literature. [4][5][6][7][8][9][10] A unified departmental protocol for such decision making can help in times of uncertainty.…”

Section: Triage Of Cases and Patient Managementmentioning

confidence: 99%

Managing a Specialty Service During the COVID-19 Crisis: Lessons From a New York City Health System

et al. 2020

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The COVID-19 pandemic has stretched health care resources to a point of crisis throughout the world. To answer the call for care, health care workers in a diverse range of specialties are being retasked to care for patients with COVID-19. Consequently, specialty services have had to adapt to decreased staff available for coverage coupled with a need to remain available for specialty-specific emergencies, which now require a dynamic definition. In this Invited Commentary, the authors describe their experiences and share lessons learned regarding triage of patients, staff safety, workforce management, and the psychological impact as they have adapted to a new reality in the Department of Neurosurgery at Montefiore Medical Center, a COVID-19 hot spot in New York City.

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Unfavorable functional outcome is expected for elderly patients suffering from acute subdural hematoma even when presenting with preserved level of consciousness

Cited by 7 publications

References 19 publications

Acute subdural hematoma in the elderly: outcome analysis in a retrospective multicentric series of 213 patients

Acute subdural hematoma in the elderly: outcome analysis in a retrospective multicentric series of 213 patients

Acute subdural haematoma in the elderly: to operate or not to operate? A systematic review and meta-analysis of outcomes following surgery

Managing a Specialty Service During the COVID-19 Crisis: Lessons From a New York City Health System

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