Does the Timing of the Surgery Have a Major Role in Influencing the Outcome in Elders with Acute Subdural Hematomas?

Trevisi, Gianluca; Scerrati, Alba; Rustemi, Oriela; Ricciardi, Luca; Ius, Tamara; Auricchio, Anna Maria; Bonis, Pasquale De; Albanese, Alessio; Mangiola, Annunziato; Maugeri, Rosario; Nicolosi, Federico; Sturiale, Carmelo Lucio

doi:10.3390/jpm12101612

Cited by 4 publications

(9 citation statements)

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“…1 ). 2 7 16 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 In the 42 articles within the quantitative analysis, 34 articles included patients operated on for ASDH, 2 16 24 25 26 27 30 31 33 34 35 37 38 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 …”

Section: Resultsmentioning

confidence: 99%

“…Fourteen point six percent (6/41) of the studies, accounting for 523 patients, reported radiologic factors influencing the functional outcome of patients suffering from ASDH. 7,54,56,[58][59][60] Midline shift appeared as the sole factor considered to be significantly associated with functional outcome (significant n ¼ 349, p ¼ 0.038; nonsignificant n ¼ 112). Brain contusion was considered to be possibly associated with functional outcome (significant n ¼ 62, p ¼ 0.037; nonsignificant n ¼ 213).…”

Section: Radiologic Factors Influencing Functional Outcome In the Eld...mentioning

confidence: 98%

“…1). 2,7,16, In the 42 articles within the quantitative analysis, 34 articles included patients operated on for ASDH, 2,16,[24][25][26][27]30,31,[33][34][35]37,38,[40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][57][58][59][60][61] whereas seven articles included ASDH patients managed either medically or surgically. 7,28,29,32,36,39,56…”

Section: Database Researchmentioning

confidence: 99%

“…Lastly, four factors were considered not to be significantly associated with mortality: sex (n ¼ 44), medication with blood thinners (n ¼ 106), delay from trauma to surgery (n ¼ 136), and seizures (n ¼ 62) (►Table 5). ity of old patients suffering from ASDH 54,60. Midline shift on CT (computed tomography) scan was the only factor that was considered to be significantly associated with mortality (n ¼ 136, p ¼ 0.044).…”

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confidence: 99%

“…Four factors were considered to significantly associated with functional outcome: ASDH volume (significant n ¼ 604, p ¼ 0.014), temporal uncus herniation (n ¼ 124, p ¼ 0.03), traumatic axonal injury (n ¼ 81, p ¼ 0.03), and loss of basal cisterns (significant n ¼ 791, p ¼ 0.037; nonsignificant n ¼ 205). Four factors were considered to be possibly associated with functional outcome: ASDH thickness (significant n ¼ 880, p ¼ 0.039; nonsignificant n ¼ 788), midline shift (significant n ¼ 826, p ¼ 0.0473; nonsignificant n ¼ 945), brain contusion (significant n ¼ 841, p < 0.05; nonsignificant n ¼ 724), and traumatic subarachnoid hemorrhage (significant n ¼ 522, p < 0.05; nonsignificant n ¼ 724) (►Table 4).ElderlyClinical Factors Influencing mortality in the ElderlySeven point three percent (3/41) of the studies, accounting for 242 patients, reported clinical factors influencing the mortality of patients suffering from ASDH 45,54,60. Low postoperative GCS score was the only factor considered to be significantly associated with mortality (n ¼ 62, p ¼ 0.0000076).…”

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confidence: 99%

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Prognostic Factors of Mortality and Functional Outcome for Acute Subdural Hematoma: A Review Article

Beucler

2023

Asian J Neurosurg

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Acute subdural hematoma (ASDH) is the most frequent intracranial traumatic lesion requiring surgery in high-income countries. To date, uncertainty remains regarding the odds of mortality or functional outcome of patients with ASDH, regardless of whether they are operated on. This review aims to shed light on the clinical and radiologic factors associated with ASDH outcome. A scoping review was conducted on Medline database from inception to 2023. This review yielded 41 patient series. In the general population, specific clinical (admission Glasgow Coma Scale [GCS], abnormal pupil exam, time to surgery, decompressive craniectomy, raised postoperative intracranial pressure) and radiologic (ASDH thickness, midline shift, thickness/midline shift ratio, uncal herniation, and brain density difference) factors were associated with mortality (grade III). Other clinical (admission GCS, decompressive craniectomy) and radiologic (ASDH volume, thickness/midline shift ratio, uncal herniation, loss of basal cisterns, petechiae, and brain density difference) factors were associated with functional outcome (grade III). In the elderly, only postoperative GCS and midline shift on brain computed tomography were associated with mortality (grade III). Comorbidities, abnormal pupil examination, postoperative GCS, intensive care unit hospitalization, and midline shift were associated with functional outcome (grade III). Based on these factors, the SHE (Subdural Hematoma in the Elderly) and the RASH (Richmond Acute Subdural Hematoma) scores could be used in daily clinical practice. This review has underlined a few supplementary factors of prognostic interest in patients with ASDH, and highlighted two predictive scores that could be used in clinical practice to guide and assist clinicians in surgical indication.

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Section: Resultsmentioning

confidence: 99%

Section: Radiologic Factors Influencing Functional Outcome In the Eld...mentioning

confidence: 98%

Section: Database Researchmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Prognostic Factors of Mortality and Functional Outcome for Acute Subdural Hematoma: A Review Article

Beucler

2023

Asian J Neurosurg

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Clinical outcomes and hemorrhagic or thromboembolic risks in decompressive craniectomy for patients taking antiplatelet or anticoagulant therapy.

Scerrati,

Scanferla,

Sgarbanti

et al. 2024

Preprint

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Background Decompressive craniectomy (DC) is a critical surgical intervention for elevated intracranial pressure. However, the impact of preoperative antiplatelet or anticoagulant therapy on outcomes and complications remains unclear. Methods A retrospective-prospective study was conducted on 145 patients undergoing DC between November 2021 and May 2023. Patients were categorized into two groups: those with (n = 48) and without (n = 97) preoperative antithrombotic therapy. Demographic data, comorbidities, antithrombotic therapy type and duration, clinical outcomes, and pre-operative risk factors (CHA2DS2-VASc and HAS-BLED scores) were analyzed. Results While there was a trend towards higher hemorrhagic complications in the antithrombotic therapy group (20.0% vs. 11.3%), this difference was not statistically significant. However, thromboembolic events, primarily stroke (27.7% vs. 9.3%) and acute myocardial infarction (10.6% vs. 0.0%), were significantly more frequent in the antithrombotic therapy group. Multivariate analysis revealed that ischemic stroke as a primary diagnosis, rather than antithrombotic therapy itself, was a significant predictor of thromboembolic complications (adjusted OR 3.49, 95%CI 1.47–8.28, p = 0.005). Pre-operative GCS was associated with improved outcomes (adjusted OR 0.81, 95%CI 0.67–0.97, p = 0.025). Conclusion While antithrombotic therapy does not appear to increase the risk of hemorrhagic complications after DC, it is associated with a higher risk of thromboembolic events, especially in patients with ischemic stroke. Individualized assessment and tailored management of antithrombotic therapy are crucial to optimize outcomes in DC patients. Further studies are needed to refine strategies for bridging anticoagulation and managing antithrombotic therapy in this population, considering factors such as CHA2DS2-VASc and HAS-BLED scores, as well as patient-specific risk profiles.

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Outcome after decompressive craniectomy in older adults after traumatic brain injury

Kapapa,

Jesuthasan,

Schiller

et al. 2024

Front. Med.

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ObjectiveGlobally, many societies are experiencing an increase in the number of older adults (>65 years). However, there has been a widening gap between the chronological and biological age of older adults which trend to a more active and social participating part of the society. Concurrently, the incidence of traumatic brain injury (TBI) is increasing globally. The aim of this study was to investigate the outcome after TBI and decompressive craniectomy (DC) in older adults compared with younger patients.MethodsA retrospective, multi-centre, descriptive, observational study was conducted, including severe TBI patients who were treated with DC between 2005 and 2022. Outcome after discharge and 12 months was evaluated according to the Glasgow Outcome Scale (Sliding dichotomy based on three prognostic bands). Significance was established as p ≤ 0.05.ResultsA total of 223 patients were included. The majority (N = 158, 70.9%) survived TBI and DC at discharge. However, unfavourable outcome was predominant at discharge (88%) and after 12 months (67%). There was a difference in favour of younger patients (≤65 years) between the age groups at discharge (p = 0.006) and at 12 months (p < 0.001). A subgroup analysis of the older patients (66 to ≤74 vs. ≥75 years) did not reveal any significant differences. After 12 months, 64% of the older patients had a fatal outcome. Only 10% of those >65 years old had a good or very good outcome. 25% were depending on support in everyday activities. After 12 months, the age (OR 0.937, p = 0.007, CI 95%: 0.894–0.981; univariate) and performed cranioplasty (univariate and multivariate results) were influential factors for the dichotomized GOS. For unfavourable outcome after 12 months, the thresholds were calculated for age = 55.5 years (p < 0.001), time between trauma and surgery = 8.25 h (p = 0.671) and Glasgow Coma Scale (GCS) = 4 (p = 0.429).ConclusionEven under the current modern conditions of neuro-critical care, with significant advances in intensive care and rehabilitation medicine, the majority of patients >65 years of age following severe TBI and DC died or were dependent and usually required extensive support. This aspect should also be taken into account during decision making and counselling (inter-, intradisciplinary or with relatives) for a very mobile and active older section of society, together with the patient’s will.

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Does the Timing of the Surgery Have a Major Role in Influencing the Outcome in Elders with Acute Subdural Hematomas?

Cited by 4 publications

References 36 publications

Prognostic Factors of Mortality and Functional Outcome for Acute Subdural Hematoma: A Review Article

Prognostic Factors of Mortality and Functional Outcome for Acute Subdural Hematoma: A Review Article

Clinical outcomes and hemorrhagic or thromboembolic risks in decompressive craniectomy for patients taking antiplatelet or anticoagulant therapy.

Outcome after decompressive craniectomy in older adults after traumatic brain injury

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