Short- and Long-Term Geriatric Mortality After Acute Traumatic Subdural Hemorrhage

Benko, Michael J.; Abdulla, Sarah; Cuoco, Joshua A.; Dhiman, Nitasha; Klein, Brendan J.; Guilliams, Evin L.; Marvin, Eric A.; Howes, Gregory A.; Collier, Bryan R.; Hamill, Mark E.

doi:10.1016/j.wneu.2019.06.086

Cited by 16 publications

(10 citation statements)

References 19 publications

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“…Regarding the type of cerebral bleeding, half of patients admitted to our Internal Medicine wards presented with subdural haematoma, confirming a high prevalence of this type of bleeding in very elderly patients, which is often secondary to trauma or falls in these patients [22]. Another interesting finding of our study relates the use of PPI, which was common in our population (43.9%).…”

Section: Discussionsupporting

confidence: 71%

Clinical and pharmacological characteristics of elderly patients admitted for bleeding: impact on in-hospital mortality

et al. 2020

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Introduction: Clinical and pharmacological characteristics of elderly patients hospitalized for bleeding and in-hospital mortality according to bleeding type are barely described. Methods: Retrospective cohort study of 13,496 consecutive patients admitted to internal medicine wards. Clinical characteristics, comorbidities and pharmacological treatments were collected for each patient. Predictors of in-hospital mortality were investigated. Results: Overall, 531 (3.9%) patients were admitted for bleeding: 189 clinically relevant nonmajor bleeding, 106 cerebral and 236 major non-cerebral (95.8% gastrointestinal (GI)). Among 106 cerebral bleedings, 28.3% and 24.5% were typical and atypical intracranial, respectively, and 47.2% were subdural haemorrhages. Most of patients with GI bleeding presented with anaemia (90.7%). A similar rate of GI bleeding was found in aspirin-treated patients taking or not proton pump inhibitors (PPI). In-hospital mortality was 9.98%. Age !80 years (odds ratio (OR) 2.513, p¼.005), cerebral bleeding (OR 5.373, p<.001), eGFR <30 ml/min/m 2 (OR 2.388, p¼.035) and COPD (OR 2.362, p¼.024) were positively associated with mortality, while ACE inhibitors/ARBs use was negatively associated (OR 0.383, p¼.028). Conclusions: The most frequent type of major haemorrhage was GI bleeding, which was not modified by the use of PPI in patients taking aspirin. Cerebral bleeding increased all-cause death, which was lower in ACE inhibitors/ARBs users. KEY MESSAGE Gastrointestinal (GI) bleeding was the most common reason for hospital admission. The rate of GI bleeding was similar in patients on aspirin using or not PPI. Cerebral bleeding increased in-hospital mortality, which was lower in patients taking ACE inhibitors/ARBs.

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Section: Discussionsupporting

confidence: 71%

Clinical and pharmacological characteristics of elderly patients admitted for bleeding: impact on in-hospital mortality

et al. 2020

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“…In the past, surgery was the first‐line management of body packers. Surgical intervention will be used mainly in cases with symptoms of leakage or intestinal obstruction, and it will be more conservatively managed with purgation or close monitoring until discharged naturally 15,16 …”

Section: Discussionmentioning

confidence: 99%

Methamphetamine poisoning due to body packer swallowing in a prisoner

Rouhani

Zakariaei

Malakian

et al. 2022

Clinical Case Reports

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“…With the increase in the mean age of the world population, the incidence of head injury and acute subdural hematoma (ASDH) in the elderly is simultaneously raising [ 1 ]. Traumatic ASDH in elderly patients is generally associated with a poor outcome [ 2 , 3 ]. Current guidelines on optimal treatment of these patients are based on weak evidences and, despite being considered a life-saving procedure, the role of surgery remains debated [ 4 , 5 , 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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

Trevisi

Scerrati

Rustemi

et al. 2022

JPM

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Background: The incidence of traumatic acute subdural hematomas (ASDH) in the elderly is increasing. Despite surgical evacuation, these patients have poor survival and low rate of functional outcome, and surgical timing plays no clear role as a predictor. We investigated whether the timing of surgery had a major role in influencing the outcome in these patients. Methods: We retrospectively retrieved clinical and radiological data of all patients ≥70 years operated on for post-traumatic ASDH in a 3 year period in five Italian hospitals. Patients were divided into three surgical timing groups from hospital arrival: ultra-early (within 6 h); early (6–24 h); and delayed (after 24 h). Outcome was measured at discharge using two endpoints: survival (alive/dead) and functional outcome at the Glasgow Outcome Scale (GOS). Univariate and multivariate predictor models were constructed. Results: We included 136 patients. About 33% died as a result of the consequences of ASDH and among the survivors, only 24% were in good functional outcome at discharge. Surgical timing groups appeared different according to presenting the Glasgow Outcome Scale (GCS), which was on average lower in the ultra-early surgery group, and radiological findings, which appeared worse in the same group. Delayed surgery was more frequent in patients with subacute clinical deterioration. Surgical timing appeared to be neither associated with survival nor with functional outcome, also after stratification for preoperative GCS. Preoperative midline shift was the strongest outcome predictor. Conclusions: An earlier surgery was offered to patients with worse clinical-radiological findings. Additionally, after stratification for GCS, it was not associated with better outcome. Among the radiological markers, preoperative midline shift was the strongest outcome predictor.

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Short- and Long-Term Geriatric Mortality After Acute Traumatic Subdural Hemorrhage

Cited by 16 publications

References 19 publications

Clinical and pharmacological characteristics of elderly patients admitted for bleeding: impact on in-hospital mortality

Clinical and pharmacological characteristics of elderly patients admitted for bleeding: impact on in-hospital mortality

Methamphetamine poisoning due to body packer swallowing in a prisoner

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

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