Chronic Subdural Hematoma: A Sentinel Health Event

Dumont, Travis M.; Rughani, Anand I.; Goeckes, Tara; Tranmer, Bruce I.

doi:10.1016/j.wneu.2012.06.026

Cited by 78 publications

(69 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The overall survival of patients in the surgical group was higher than that of patients in the conservative group. Although several studies have shown an increase in mortality rates associated with drainage of chronic SDHs in elderly patients, 9,14,18 the results of our study have shown that surgical drainage is associated with a long-term overall survival benefit even in patients aged over 90 years old.…”

Section: Survival Outcomescontrasting

confidence: 48%

Outcomes of chronic subdural hematoma drainage in nonagenarians and centenarians: a multicenter study

Lee

Ker

et al. 2016

JNS

View full text Add to dashboard Cite

o drain, or not to drain, that is the question." Chronic subdural hemorrhage (SDH) or hematoma is a predominantly neurological condition usually resulting from trauma and affecting elderly individuals. 2,3,14,19 Chronic SDH is not a benign condition and is regarded as a sentinel health event because of its high morbidity and mortality rates in older people.9,18 The treatment of choice for managing chronic SDHs is surgical drainage. 12,23 Large studies have shown that older age independently contributes to increased mortality and morbidity rates after the surgical drainage of chronic SDHs. 10,22,24 As the world's elderly population increases because of adabbreviatioNs CCI = Charlson Comorbidity Index; GCS = Glasgow Coma Scale; KPS = Karnofsky Performance Scale; LOS = length of stay; SDH = subdural hemorrhage. submitted September 5, 2014. accepted December 18, 2014. iNclude wheN citiNg Published online July 10, 2015; DOI: 10.3171/2014.12.JNS142053. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. obJective Chronic subdural hemorrhage (SDH) or hematoma is a condition that affects elderly individuals. With advances in medical care, the number of nonagenarians and centenarians will increase. However, surgical treatments in this age group are associated with high rates of morbidity and mortality. Because no data are available on the rates of survival among elderly patients with chronic SDHs who undergo surgical drainage or receive only conservative care, the goal of this study was to determine survival rates in patients 90 years of age or older with symptomatic chronic SDHs. methods The authors conducted a retrospective analysis of patient data that were collected at 3 hospitals over a 13-year period (from January 2001 to June 2013). The data from patients 90 years or older with symptomatic chronic SDHs and who were offered surgical treatment were included in the analysis. Patients who underwent surgical treatment were included in the surgical group and patients who declined an operation were included in the conservative care group. The patients' Charlson Comorbidity Index score, Karnofsky Performance Scale score, dates of death, presenting symptoms, Glasgow Coma Scale score, length of stay in the hospital, discharge location, side of the SDH, and neurological improvements at 30-day and 6-month follow-ups were recorded. Data were statistically analyzed with Fisher exact test, Kaplan-Meier curves, and logistic regression. results In total, 101 patients met the inclusion criteria of this study; 70 of these patients underwent surgical drainage, and 31 received conservative care. Patients in the surgical group had statistically significantly (p < 0.001) higher survival at both the 30-day and 6-month follow-ups, with 92.9% and 81.4% of the patients in this group surviving for at least 30 days and 6 months, respectively, versus 58.1% and 41.9%, respectively, in the conservative care group. Moreover, the mean overall length o...

show abstract

Section: Survival Outcomescontrasting

confidence: 48%

Outcomes of chronic subdural hematoma drainage in nonagenarians and centenarians: a multicenter study

Lee

Ker

et al. 2016

JNS

View full text Add to dashboard Cite

show abstract

“…Chronic subdural haematoma (CSDH) is a common neurosurgical condition whose incidence and prevalence increase with age [1][2][3][4]. Surgical drainage is the gold standard treatment for the management of symptomatic CSDH [5,6].…”

Section: Introductionmentioning

confidence: 99%

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

Christopher

Poon²,

Glancz

et al. 2018

Neurosurg Rev

View full text Add to dashboard Cite

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.

show abstract

“…2 The annual estimated incidence is 13.5 per 100,000 persons per year in the general population and for those above the age of 65 years can be up to 58.1 per 100,000 persons per year. 3 It is associated with a higher mortality with increased standardised mortality ratio up to 2.9 4 which challenge the concept of it being a benign condition. 5 Burr-hole for drainage is an effective treatment.…”

Section: Introductionmentioning

confidence: 99%

The use of atorvastatin for chronic subdural haematoma: a retrospective cohort comparison study

Chan

Sun

et al. 2016

British Journal of Neurosurgery

View full text Add to dashboard Cite

Chronic subdural haematoma (CSDH) is a common neurosurgical condition. Burr-hole for drainage is an effective treatment. However, recurrence can be up to 8-33% and is associated with morbidities and mortalities. The underlying pathogenesis was postulated to be localised inflammation and pathological aberrant vessels formation. Atorvastatin, an HMG-CoA reductase inhibitor, is a type of lipid-lowering medication. In animal studies and a preliminary clinical trial, Atorvastatin was shown to be effective in the treatment of CSDH. It was found to inhibit inflammation and promote vascular maturation at the neomembrane of CSDH. Our study aimed to investigate the efficacy of Atorvastatin in CSDH. During the study period from January to December 2014, Atorvastatin was used in 12 CSDH patients with Glasgow Coma Scale (GCS) 13-15 or Markwalder's Grading Scale (MGS) Grade 0-2. They were retrospectively compared with GCS-and MGS-matched controls who had not used statin. Improvement with haematoma resolution at 3 months was 75% (9/12) for the Atorvastatin group, versus 42% (5/12) for the Control group (p ¼ 0.0977). The risk of deterioration requiring burr-hole drainage was 16.7% (2/12) in the Atorvastatin group, versus 58.3% (7/12) in the Control group (p ¼ 0.0447). The Odds Ratio (OR) of deterioration requiring burr-hole drainage with Atorvastatin was 0.143 (95%CI: 0.021-0.958), which favours the use of Atorvastatin in CSDH (p ¼ 0.0451). The Number needed to treat (NNT) was 2.4 (p ¼ 0.0447; 95%CI: 1.31-14.93). In conclusion, this retrospective cohort comparison study has shown that CSDH with Atorvastatin had a lower rate of deterioration and burr-hole drainage.ARTICLE HISTORY

show abstract

Chronic Subdural Hematoma: A Sentinel Health Event

Cited by 78 publications

References 13 publications

Outcomes of chronic subdural hematoma drainage in nonagenarians and centenarians: a multicenter study

Outcomes of chronic subdural hematoma drainage in nonagenarians and centenarians: a multicenter study

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

The use of atorvastatin for chronic subdural haematoma: a retrospective cohort comparison study

Contact Info

Product

Resources

About