Causes and Trauma Apportionment Score of Chronic Subdural Hematoma

Abstract

ObjectiveThe pathophysiology of chronic subdural hematoma (CSH) is not yet clear. Trauma alone is not sufficient to result in CSH in young individuals, while a trivial injury can result in CSH in older adults. Although the causality and apportionment of trauma are important issues in CSH, especially in terms of insurance, it is too obscure to solve all struggles.MethodsThere are three key factors for producing CSH. First, CSH necessitates a potential subdural reservoir. Other important precipitating factors are trauma and coagulopathy. However, these factors are not sufficient to cause CSH development. The trauma apportionment score (TAS) can be used to compare the relative importance of these three factors. Here, we applied the TAS to 239 consecutive cases of CSH. We retrospectively obtained the patients' history and laboratory results from their medical records.ResultsThe TAS ranged from −5 to 5. The most common score was 0. If we defined the cause of CSH as being combined when the TAS was 0, then the cause was combined in 30 cases (12.6%). If we extended the criteria for a combined cause from 0 to −1 to 1, the cause was combined in 107 cases (44.8%). Regardless of the criteria used, traumatic CSHs were more common than were spontaneous CSHs. Spontaneous CSHs were more common in older than in younger patients (p<0.01, Fisher's exact test).ConclusionThe TAS is a useful tool for differentiating the causality of CSH.

Comparisons of Radiological and Clinical Characteristics between Traumatic and Non-traumatic Subdural Hematoma Patients

“… 8) Other important precipitating factors are trauma and coagulopathy. 9) Severe brain atrophy and larger subdural space volumes are prone to SDH development when head trauma has occurred. 6) In this study, brain atrophy was not common in the traumatic SDH group.…”