Predictors of mortality in nontraumatic subdural hematoma

Busl, Katharina M.; Prabhakaran, Shyam

doi:10.3171/2013.4.jns122236

Cited by 29 publications

(25 citation statements)

References 36 publications

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“…A large epidemiological study reported major organ dysfunction as an independent predictor of mortality. 1,24 Our results showed that the short-term prognosis (acute phase) in elderly patients depends not on comorbidities but on the severity of aSDH, which is expressed by pupillary abnormalities or unconsciousness. 7 Nonetheless, long-term prognosis (3 months' follow-up) in survivors of aSDH also depends on the cumulating comorbidities.…”

Section: Discussionmentioning

confidence: 95%

Significant increase in acute subdural hematoma in octo- and nonagenarians: surgical treatment, functional outcome, and predictors in this patient cohort

Won¹,

Dubinski²,

Brawanski³

et al. 2017

Neurosurgical Focus

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OBJECTIVEAcute subdural hematoma (aSDH) is a common disease increasing in prevalence given the demographic growth of the aging population. Yet, the benefit of surgical treatment for aSDH and the subsequent functional outcome in elderly patients (age ≥ 80 years) remain unclear. Therefore, the aims of this study were to evaluate the incidence of aSDH in patients 80 years or older, determine overall functional outcome, identify predictors of an unfavorable or favorable outcome, and establish specific risk factors for seizures.METHODSThe authors retrospectively analyzed patients 80 years and older who presented with isolated aSDH in the past 10 years at their institution. The following parameters were assessed: baseline characteristics, clinical status on admission and 24 hours after surgery, and clinical course. Functional outcome was assessed at discharge and the 3-month follow-up (FU).RESULTSIn the period from January 2007 to December 2016, 165 patients with aSDH were admitted to the authors’ institution. Sixty-eight patients (41.2%) were 80 years old or older, and the mean age overall was 85 years (range 80–96 years). The incidence of aSDH in the elderly had significantly increased over past decade, with more than 50% of patients admitted to our institution for aSDH now being 80 years or older. The overall mortality rate was 28% at discharge and 48% at the FU. Independent predictors of an unfavorable outcome at discharge were a GCS score ≤ 8 at 24 hours after operation (p < 0.001) and pneumonia (p < 0.02). At the FU, a GCS score ≤ 8 at 24 hours after operation (p < 0.001) and cumulative comorbidities (≥ 5; p < 0.05) were significant independent predictors. All patients with more than 6 comorbidities had died by the FU. Surgical treatment in comatose compared to noncomatose patients had statistically significant, higher mortality rates at discharge and the FU. Still, 23% of the comatose patients and more than 50% of the noncomatose patients had a favorable outcome at the FU (p = 0.06).CONCLUSIONSThe number of octo- and nonagenarians with aSDH significantly increased over the last decade. These patients can achieve a favorable outcome, especially those with a noncomatose status and fewer than 5 comorbidities. Surgical and nonsurgical treatment of octo- and nonagenarians during and after discharge should be optimized to increase clinical improvement.

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Section: Discussionmentioning

confidence: 95%

Significant increase in acute subdural hematoma in octo- and nonagenarians: surgical treatment, functional outcome, and predictors in this patient cohort

Won¹,

Dubinski²,

Brawanski³

et al. 2017

Neurosurgical Focus

View full text Add to dashboard Cite

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“…In terms of reoperation, repeat surgery was required in 58 cases (8%), consistent with previous estimates. 4,13 It should be noted that as with comorbidities, many of the adverse events described here could be ascribed more to the natural history of SDH rather than to surgical intervention, and these outcomes could occur more frequently without intervention. The order of causation-that is, which comes first-is unknown, but the associations are present.…”

Section: Adverse Eventsmentioning

confidence: 99%

“…4,10 However, nontraumatic SDH in this context does not represent true spontaneous hemorrhage, but rather an SDH without a documented known injury. Hence, despite the difference in coding, these patients were considered together in this study.…”

Section: Patient Populationmentioning

confidence: 99%

“…This is similar to the 15% operatively treated traumatic SDH mortality rate, but substantially higher than the 7% operatively treated nontraumatic SDH mortality rate from NIS data. 4,10 The most likely explanation for this more than 2-fold difference is that NIS only captures inpatient mortality, whereas NSQIP captures all deaths within 30 days, including at home, in rehabilitation facilities, and in hospices. 1 In addition, the distinction between a traumatic and a nontraumatic SDH based on ICD-9 coding appears dubious, as truly nontraumatic SDH is a rare condition.…”

Section: Mortality Ratementioning

confidence: 99%

“…These groups have found a mortality rate of 15% for traumatic SDH treated operatively, 7% for nontraumatic SDH treated operatively, and 12% for SDH overall. 4,6,10 Although these above-noted NIS studies have clarified the modern risk of death associated with surgical evacuation of SDH in the US, the general health morbidity associated with surgical treatment of SDH has not been examined. However, the NIS database, while a valuable resource, only captures complications that occur during inpatient stays.…”

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confidence: 99%

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Patient factors associated with 30-day morbidity, mortality, and length of stay after surgery for subdural hematoma: a study of the American College of Surgeons National Surgical Quality Improvement Program

Lukasiewicz

Grant

Basques

et al. 2016

JNS

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Subdural hematoma (SDH) is a common condition confronting neurosurgeons, resulting in more than 90,000 hospitalizations annually. 6 Morbidity, mortality, and length of stay (LOS) in patients treated with surgical evacuation of SDH are not well described, and the patient characteristics associated with adverse outcomes are not clearly established.Positive outcomes following surgery for SDH have been demonstrated, particularly in young patients and in patients treated within 4 hours of injury. 9,18,19 However, this population has a known significant risk of death. Historically, death after surgical evacuation of SDH has been reported in the range of 30%-60%. 5,12,20,22 More recently, 3 groups have investigated the mortality risk of SDH using abbreviatioNs ACS = American College of Surgeons; ASA = American Society of Anesthesiologists; BMI = body mass index; CHF = congestive heart failure; CPT = Current Procedural Terminology; DVT = deep venous thrombosis; ICD-9 = International Classification of Diseases, Ninth Revision; LOS = length of stay; MI = myocardial infarction; NIS = National Inpatient Sample; NSQIP = National Surgical Quality Improvement Project; OR = operating room; PE = pulmonary embolism; RR = relative risk; SDH = subdural hematoma. results A total of 746 surgical procedures performed for SDH were identified and analyzed. Patients undergoing this procedure were 64% male with an average age (± SD) of 70.9 ± 14.1 years. The most common individual adverse events were death (17%) and intubation for more than 48 hours (19%). In total, 34% experienced a serious adverse event other than death, 8% of patients returned to the operating room (OR), and the average hospital LOS was 9.8 ± 9.9 days. In multivariate analysis, reduced mortality was associated with age less than 60 years (relative risk coNclusioNs Adverse outcomes are common after surgery for SDH. In this study, 18% of the patients died within 30 days of surgery. Factors associated with adverse outcomes were identified. Patients and families should be counseled about the serious risks of morbidity and death associated with acute traumatic SDH requiring surgery.[http://thejns.org/doi/abs/10.3171/2015.2.JNS142721

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Association Between Post–Dural Puncture Headache After Neuraxial Anesthesia in Childbirth and Intracranial Subdural Hematoma

2020

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IMPORTANCE Women giving birth have high rates of dural puncture secondary to neuraxial anesthesia and are at high risk for a resulting headache. It appears to be unknown whether there is a significant association between post-dural puncture headache and subsequent intracranial subdural hematoma. OBJECTIVE To determine the association of post-dural puncture headache with postpartum intracranial subdural hematoma. DESIGN, SETTING, AND PARTICIPANTS This cohort study of patients used hospital discharges recorded in the US Agency for Healthcare Research and Quality National Readmission Database for women who experienced childbirth from January 2010 to December 2016. Patients were included if they had been admitted for childbirth, had 2 months of follow-up data, and did not receive a diagnostic lumbar puncture. Only the first delivery for a calendar year was studied. Data were analyzed from January 2018 to June 2019. EXPOSURES Women with post-dural puncture headache associated with neuraxial anesthesia in the 2-month postpartum period were identified using International Classification of Disease (Ninth Edition and Tenth Edition) codes and were compared with those without post-dural puncture headaches. MAIN OUTCOME AND MEASURES The primary outcome was intracranial subdural hematoma in the 2-month postpartum period. Secondary outcomes included in-hospital mortality and occurrence of neurosurgery. RESULTS A total of 26 469 771 patients with 26 498 194 deliveries were included. Exclusion of repeated deliveries (n = 28 423), deliveries without 2 months of follow-up data (n = 4 329 621), and deliveries with diagnostic lumbar puncture (n = 9334) resulted in a final cohort of 22 130 815 patients and deliveries. For the cohort, the mean (SD) age was 28.1 (6.0) years, and there were 68 374 post-dural puncture headaches, for an overall rate of 309 (95% CI, 302-316) per 100 000. There were 342 cases of subdural hematoma identified, indicating a rate of 1.5 (95% CI, 1.3-1.8) per 100 000 women. Of these, 100 cases were in women with post-dural puncture headache, indicating a rate of 147 (95% CI, 111-194) hematoma cases per 100 000 deliveries in this subgroup. Post-dural puncture headache had an unadjusted absolute risk increase of 145 (95% CI, 117-174) subdural hematoma cases per 100 000 deliveries. After adjusting for confounders, post-dural puncture headache had an odds ratio for subdural hematoma of 199 (95% CI, 126-317; P < .001) and an adjusted absolute risk increase of 130 (95% CI, 90-169; P < .001) per 100 000 deliveries. CONCLUSIONS AND RELEVANCE The presence of presumed post-dural puncture headache after neuraxial anesthesia in childbirth, compared with no headache, was associated with a small but statistically significant absolute increase in the risk of being diagnosed with intracranial subdural hematoma. Further research is needed to establish if this association is causal for this rare outcome.

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Predictors of mortality in nontraumatic subdural hematoma

Cited by 29 publications

References 36 publications

Significant increase in acute subdural hematoma in octo- and nonagenarians: surgical treatment, functional outcome, and predictors in this patient cohort

Significant increase in acute subdural hematoma in octo- and nonagenarians: surgical treatment, functional outcome, and predictors in this patient cohort

Patient factors associated with 30-day morbidity, mortality, and length of stay after surgery for subdural hematoma: a study of the American College of Surgeons National Surgical Quality Improvement Program

Association Between Post–Dural Puncture Headache After Neuraxial Anesthesia in Childbirth and Intracranial Subdural Hematoma

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