External validation and modification of the Oslo grading system for prediction of postoperative recurrence of chronic subdural hematoma

Won, Sae‐Yeon; Dubinski, Daniel; Eibach, Michael; Geßler, Florian; Herrmann, Eva; Keil, Fee; Seifert, Volker; Konczalla, Juergen; Behmanesh, Bedjan

doi:10.1007/s10143-020-01271-w

Cited by 18 publications

(12 citation statements)

References 29 publications

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“…Consequently, the unilateral grading system cannot be applied to patients with bilateral CSDH. In the future, we need develop a model to predict the recurrence of bilateral CSDH ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

Brain re-expansion predict the recurrence of unilateral CSDH: A clinical grading system

Han

Feng²,

Xu³

et al. 2022

Front. Neurol.

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ObjectiveAssessing the risk of postoperative recurrence of chronic subdural hematoma (CSDH) is a clinical focus. To screen the main factors associated with the perioperative hematoma recurrence. The brain re-expansion is the core factor of recurrence. A clinical prognostic scoring system was also proposed.MethodsWe included 295 patients with unilateral CSDH as the training group for modeling. Factors predicting postoperative recurrence requiring reoperation (RrR) were determined using univariate and multivariate regression analyses, and bivariate Pearson correlation coefficient analysis was used to exclude related factors. Receiver operating characteristic curve analysis evaluates the ability of main factors to predict RrR and determines the cut-off value of brain re-expansion rate. We developed a prognostic scoring system and conducted preliminary verification. A verification group including 119 patients with unilateral CSDH was used to verify the grading systems.ResultsThe key factors for predicting unilateral CSDH recurrence were cerebral re-expansion rate (≤ 40%) at postoperative days 7–9 (OR 25.91, p < 0.001) and the preoperative CT density classification (isodense or hyperdense, or separated or laminar types) (OR 8.19, p = 0.007). Cerebral atrophy played a key role in brain re-expansion (OR 2.36, p = 0.002). The CSDH prognostic grading system ranged from 0 to 3. An increased score was associated with a more accurate progressive increase in the RrR rate (AUC = 0.856).ConclusionsOur prognostic grading system could screen clinically high-risk RrR patients with unilateral CSDH. However, increased attention should be paid to brain re-expansion rate after surgery in patients with CSDH.

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“…Consequently, the unilateral grading system cannot be applied to patients with bilateral CSDH. In the future, we need develop a model to predict the recurrence of bilateral CSDH ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

Brain re-expansion predict the recurrence of unilateral CSDH: A clinical grading system

Han

Feng²,

Xu³

et al. 2022

Front. Neurol.

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“…In addition, this study presents the largest sample size used to develop any CSDH recurrence prediction system (see Table 5 for a summary of other systems). [ 2 , 16 , 33 , 39 , 43 ]…”

Section: Discussionmentioning

confidence: 99%

“…Five CSDH recurrence or risk grading systems have been proposed. [ 2 , 16 , 33 , 39 , 43 ] The components of each grading system are described in Table 5 . The sample size for each scale is smaller than the cohort used in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Earlier studies have emphasized consideration of the subdural space (i.e., postoperative or hematoma cavity)[ 2 , 16 , 33 , 39 , 43 ] but most measured volume instead of size, as in our system (i.e., maximal thickness). Like Amoo et al .,[ 2 ] we believe that this maximal thickness measurement is more intuitive and relevant because it is a single measurement.…”

Section: Discussionmentioning

confidence: 99%

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Puerto Rico Recurrence Scale: Predicting chronic subdural hematoma recurrence risk after initial surgical drainage

Mignucci-Jiménez

Matos-Cruz

Abramov

et al. 2022

Surgical Neurology International

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Background: Chronic subdural hematoma (CSDH) commonly affects older individuals and is associated with a relatively high rate of recurrence after surgery. Many studies have created grading systems to identify patients at high risk of CSDH recurrence after the initial surgery. However, no system has been adopted widely. The authors present the first CSDH grading system created from a population-based single-center data set. Methods: A single-center Puerto Rican population-based retrospective analysis was performed on consecutive patients treated for a CSDH at a designated institution from July 1, 2017 to December 31, 2019. Univariate and multivariate analyses were used to create a CSDH recurrence grading scale. Retrospective validation was conducted on this sample population. Results: The study included 428 patients. Preoperative midline shift, postoperative midline shift, and size of postoperative subdural space differed between the recurrence and nonrecurrence groups (P = 0.03, 0.002, and 0.002, respectively). A multivariate analysis was used to create a 10-point grading scale comprising four independent variables. Recurrence rates progressively increased from the low-risk (0–3 points) to high-risk (8–10 points) groups (2.9% vs. 20.3%; P < 0.001). Conclusion: A 10-point grading scale for CSDH recurrence was developed with four components: preoperative midline shift (≤1 and >1 cm), laterality (bilateral, unilateral-right, and unilateral-left), size of postoperative subdural space (≤1.6 and >1.6 cm), and pneumocephalus (present or absent). Patients who scored higher on the scale had a higher risk of recurrence. This CSDH grading scale has implications for Puerto Rico and the general population as the elderly population increases worldwide.

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“…The nonrandomized setting left the therapy of choice in the decision of the attending physician. The SDH volume determination method (ABC/2)5 might cause a systematic error in results (up to 5% error according to Konczalla et al [ 38 ]. Although all patients received standardized treatment, retrospective design and the absence of study protocol might further corrupt the dataset.…”

Section: Limitationsmentioning

confidence: 99%

A Validation Study for SHE Score for Acute Subdural Hematoma in the Elderly

et al. 2022

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Objective: The aim of this study was the verification of the Subdural Hematoma in the Elderly (SHE) score proposed by Alford et al. as a mortality predictor in patients older than 65 years with nontraumatic/minor trauma acute subdural hematoma (aSDH). Additionally, we evaluated further predictors associated with poor outcome. Methods: Patients were scored according to age (1 point is given if patients were older than 80 years), GCS by admission (1 point for GCS 5–12, 2 points for GCS 3–4), and SDH volume (1 point for volume 50 mL). The sum of points determines the SHE score. Multivariate logistic regression analysis was performed to identify additional independent risk factors associated with 30-day mortality. Results: We evaluated 131 patients with aSDH who were treated at our institution between 2008 and 2020. We observed the same 30-day mortality rates published by Alford et al.: SHE 0: 4.3% vs. 3.2%, p = 1.0; SHE 1: 12.2% vs. 13.1%, p = 1.0; SHE 2: 36.6% vs. 32.7%, p = 0.8; SHE 3: 97.1% vs. 95.7%, p = 1.0 and SHE 4: 100% vs. 100%, p = 1.0. Additionally, 18 patients who developed status epilepticus (SE) had a mortality of 100 percent regardless of the SHE score. The distribution of SE among the groups was: 1 for SHE 1, 6 for SHE 2, 9 for SHE 3, and 2 for SHE 4. The logistic regression showed the surgical evacuation to be the only significant risk factor for developing the seizure. All patients who developed SE underwent surgery (p = 0.0065). Furthermore, SHE 3 and 4 showed no difference regarding the outcome between surgical and conservative treatment. Conclusions: SHE score is a reliable mortality predictor for minor trauma acute subdural hematoma in elderly patients. In addition, we identified status epilepticus as a strong life-expectancy-limiting factor in patients undergoing surgical evacuation.

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External validation and modification of the Oslo grading system for prediction of postoperative recurrence of chronic subdural hematoma

Cited by 18 publications

References 29 publications

Brain re-expansion predict the recurrence of unilateral CSDH: A clinical grading system

Brain re-expansion predict the recurrence of unilateral CSDH: A clinical grading system

Puerto Rico Recurrence Scale: Predicting chronic subdural hematoma recurrence risk after initial surgical drainage

A Validation Study for SHE Score for Acute Subdural Hematoma in the Elderly

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