Acute Subdural Hematoma in the Elderly; Clinical and CT Factors Influencing the Surgical Treatment Decision

Petridis, A. K.; Dörner, Lutz; Doukas, Alexandros; Eifrig, S.; Barth, Harald; Mehdorn, Maximilian

doi:10.1055/s-0029-1224096

Cited by 63 publications

(66 citation statements)

References 14 publications

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“…Kilaru et al (20) have also pointed out that TBI patients more than 65 years of age with GCS below 8 points demonstrated vegetative state, or dependent living in a facility and all patients with GCS score of 3 points died. Thus, low GCS has been found to be the strongest unfavorable predictive factor for elderly patients who suffered from ASDH (33,38). Surgical management in this study, however, was associated with better outcome and lower mortality for elderly patients who suffered from ASDH and had GCS scores of 6 or above (Tables 4 and 7).…”

Section: Discussionmentioning

confidence: 53%

Outcome and Surgical Management for Geriatric Traumatic Brain Injury: Analysis of 888 Cases Registered in the Japan Neurotrauma Data Bank

et al. 2014

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Section: Discussionmentioning

confidence: 53%

Outcome and Surgical Management for Geriatric Traumatic Brain Injury: Analysis of 888 Cases Registered in the Japan Neurotrauma Data Bank

et al. 2014

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“…The association between severity of disease and poor outcome has been described in numerous other studies on SDH. 10,19,24,34,35 Similarly, comorbidities such as cardiac and renal disease and coagulopathy have been associated with worse outcomes as well. 8,20 Our study has several limitations.…”

Section: Discussionmentioning

confidence: 99%

Predictors of mortality in nontraumatic subdural hematoma

Busl

Prabhakaran

2013

JNS

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Object. Subdural hematoma (SDH) is a common diagnosis in neurosurgical and neurocritical practice. Comprehensive outcome data are lacking for nontraumatic SDH. The authors determined which factors are associated with in-hospital mortality in a large sample of patients with nontraumatic SDH.Methods. Using the Nationwide Inpatient Sample, the authors selected adults who had been hospitalized in the US between 2007 and 2009 and in whom a primary diagnosis of nontraumatic SDH (ICD-9-CM code 432.1) had been made. Demographics, comorbidities, surgical treatment, and discharge outcomes were identified. Univariate and multivariate analyses were performed to identify predictors of in-hospital mortality.Results. Among 14,093 patients with acute nontraumatic SDH, the mean age was 71.4 ± 14.8 (mean ± standard deviation). In addition, 22.2% of the patients were admitted during the weekend. Surgical evacuation was performed in 51.4% of the patients, and 11.8% of all patients died during hospitalization. In multivariate analyses, patient age (adjusted OR 1.02, 95% CI 1.012-1.022), congestive heart failure (adjusted OR 1.42, 95% CI 1.19-1.71), warfarin use (adjusted OR 1.41, 95% CI 1.17-1.70), coagulopathy (adjusted OR 2.14, 95% CI 1.75-2.61), mechanical ventilation (adjusted OR 16.85, 95% CI 14.29-19.86), and weekend admission (adjusted OR 1.19, 95% CI 1.02-1.38) were independent predictors of in-hospital mortality. Race (Hispanic: adjusted OR 0.65, 95% CI 0.51-0.83; black: adjusted OR 0.78, 95% CI 0.63-0.96), urban hospital location (adjusted OR 0.69, 95% CI 0.54-0.89), and surgical SDH evacuation (adjusted OR 0.52, 95% CI 0.45-0.60) were strong independent predictors for decreased mortality.Conclusions. One in 9 patients with nontraumatic SDH dies during hospitalization. Among the several predictors of in-hospital mortality, the weekend effect and treatment with surgical evacuation are potentially modifiable factors. Further investigation may lead to improvements in management and outcomes.

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“…1 Also, a cohort study done by Baechli et al 5 showed that of 354 patients, those older than 65 years of age had rates of mortality similar to those of younger patients after undergoing neurosurgical interventions for subdural hematoma. Age may not be an adequate indicator for likelihood of postsurgical recovery; rather a clinical metric of frailty 32 and other preoperative parameters 22 have been shown to be effective in predicting survival rates postoperatively. Also, regarding the value of neurosurgical treatment among the elderly, a recent study showed that patients 70 years and older with subarachnoid hemorrhages had favorable clinical outcomes, and concluded that age should not preclude treatment.…”

Section: Discussionmentioning

confidence: 99%

Postoperative outcomes following closed head injury and craniotomy for evacuation of hematoma in patients older than 80 years

Lau

El-Sayed

Ziewacz

et al. 2012

JNS

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Object Advances in the management of trauma-induced intracranial hematomas and hemorrhage (epidural, subdural, and intraparenchymal hemorrhage) have improved survival in these conditions over the last several decades. However, there is a paucity of research investigating the relation between patient age and outcomes of surgical treatment for these conditions. In this study, the authors examined the relation between patient age over 80 years and postoperative outcomes following closed head injury and craniotomy for intracranial hemorrhage. Methods A consecutive population of patients undergoing emergent craniotomy for evacuation of intracranial hematoma following closed head trauma between 2006 and 2009 was identified. Using multivariable logistic regression models, the authors assessed the relation between age (> 80 vs ≤ 80 years) and postoperative complications, intensive care unit stay, hospital stay, morbidity, and mortality. Results Of 103 patients, 27 were older than 80 years and 76 patients were 80 years of age or younger. Older age was associated with longer length of hospital stay (p = 0.014), a higher rate of complications (OR 5.74, 95% CI 1.29–25.34), and a higher likelihood of requiring rehabilitation (OR 3.28, 95% CI 1.13–9.74). However, there were no statistically significant differences between the age groups in 30-day mortality or ability to recover to functional baseline status. Conclusions The findings suggest that in comparison with younger patients, patients over 80 years of age may be similarly able to return to preinjury functional baselines but may require increased postoperative medical attention in the forms of rehabilitation and longer hospital stays. Prospective studies concerned with the relation between older age, perioperative parameters, and postoperative outcomes following craniotomy for intracranial hemorrhage are needed. Nonetheless, the findings of this study may allow for more informed decisions with respect to the care of elderly patients with intracranial hemorrhage.

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Acute Subdural Hematoma in the Elderly; Clinical and CT Factors Influencing the Surgical Treatment Decision

Cited by 63 publications

References 14 publications

Outcome and Surgical Management for Geriatric Traumatic Brain Injury: Analysis of 888 Cases Registered in the Japan Neurotrauma Data Bank

Outcome and Surgical Management for Geriatric Traumatic Brain Injury: Analysis of 888 Cases Registered in the Japan Neurotrauma Data Bank

Predictors of mortality in nontraumatic subdural hematoma

Postoperative outcomes following closed head injury and craniotomy for evacuation of hematoma in patients older than 80 years

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