Superiority of craniotomy over supportive care for octogenarians and nonagenarians in operable acute traumatic subdural hematoma

Duehr, James; Rodríguez‐Torres, Sebastian; Njoku-Austin, Confidence; Patel, Kevin P.; Deng, Hansen; Hamilton, D. Kojo; Okonkwo, David O.; Puccio, Ava M.; Nwachuku, Enyinna L.

doi:10.1016/j.clineuro.2021.107069

Cited by 5 publications

(7 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For each patient, we retrieved the age, sex, Charlson Comorbidity Index (CCI), history of arterial hypertension, use of antithrombotic drugs, the need for an urgent coagulopathy correction at A&E admission, mechanism of injury, neurological status measured by the Glasgow Coma Scale (GCS) at admission and during the entire preoperative period, pupillary size and light reaction, neurological deficits, and seizures. Patients were divided in three GCS level groups, both at arrival and soon before surgery: mild (13)(14)(15), moderate (9)(10)(11)(12), and severe (3)(4)(5)(6)(7)(8).…”

Section: Clinical and Radiological Data Collectionmentioning

confidence: 99%

Has the Timing of the Surgery a Major Role in Influencing Outcome in Elderly Patients with Acute Subdural Hematomas?

Trevisi¹,

Scerrati²,

Rustemi³

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: The incidence of traumatic acute subdural hematomas (ASDH) in elderly is increasing. Despite surgical evacuation, these patients have poor survival and low rate of functional outcome, and surgical timing plays a no clear role as predictor. We investigated if the timing of surgery has a major role in influencing 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 years period in 5 Italian Hospitals. Patients were divided in 3 surgical timing groups from hospital arrival: ultra-early (within 6h); early (6-24h); delayed (after 24h). Outcome was measured at discharge using two endpoints: survival (alive/dead) and functional outcome at Glasgow Outcome Scale (GOS). Univariate and multivariate predictor models were constructed.Results: We included 136 patients. About 33% died for consequences of ASDH and among the survivors only 24% were in good functional outcome at discharge. Surgical timing groups appeared different according to presenting GCS, which was on average lower in 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 associated neither 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. Also after stratification for GCS it was not associated with better outcome. Among the radiological markers, preoperative midline shift was the strongest outcome predictor.

show abstract

Section: Clinical and Radiological Data Collectionmentioning

confidence: 99%

Has the Timing of the Surgery a Major Role in Influencing Outcome in Elderly Patients with Acute Subdural Hematomas?

Trevisi¹,

Scerrati²,

Rustemi³

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Kesiapan keluarga sangat mempengaruhi proses pelaksanaan bedah saraf dan dampaknya setelah operasi. Sehingga keluarga perlu waktu untuk mempersiapkan diri menghadapi stress terutama risiko dan akibat setelah operasi dilaksanakan (Duehr et al, 2022). Selain itu, kesiapan keluarga dipengaruhi sejauh mana keluarga mendapatkan informasi dari yang akurat dari tim kesehatan dan kemampuannya dalam mengelola informasi kesehatan (Makama, et al, 2017).…”

Section: Pendahuluanunclassified

“…Penelitian ini mendapatkan hasil, terdapat hubungan yang bermakna antara kesiapan keluarga dengan dukungan keluarga menghadapi operasi. Studi ini sesuai dengan yang telah dilakukan oleh Duehr et al, (2022). Keterkaitan ini juga menunjukkan penguatan bagi keluarga yang memiliki kesiapan menghadapai operasi lebih baik, sehingga risiko akibat pengambilan keputusan tersebut (Axelsson, et al, 2020).…”

Section: Pembahasanunclassified

See 1 more Smart Citation

Kesiapan Dan Dukungan Keluarga Sebelum Tindakan Neuro Anestesi Pada Pasien Operasi Bedah Saraf Di Rsud Jawa Tengah

Susilo

Ghofur

Harmilah

et al. 2022

QJK

View full text Add to dashboard Cite

Operasi bedah saraf dengan neuro anestesi merupakan tindakan operasi yang tergolong operasi besar dan serius. Operasi ini memerlukan kesiapan dan dukungan keluarga yang memadai. Penelitian ini bertujuan untuk menganalisis keterkaitan antara kesiapan dengan dukungan keluarga menghadapi operasi bedah saraf dengan neuro anestesi. Studi ini menggunakan pendekatan cross sectional, dengan jumlah sampel sebanyak 89 keluarga pasien bedah saraf di 7 RSUD Propinsi Jawa Tengah. Tehnik samping menggunakan stratified random sampling. Pengumpulan data menggunakan kuesioner dukungan keluarga, dan analisis data menggunakan chi-square test. Hasil studi menunjukkan sebagian besar keluarga telah siap menghadapi operasi (82%), sedangkan hanya sebagian kecil keluarga yang memberikan dukungan pada pasien menghadapi operasi (42,7%). Sementara itu, terdapat hubungan signifikan antara kesiapan dengan dukungan keluarga menghadapi bedah saraf dengan neuro anestesi dengan nilai p value < p 0,005. Kesimpulan penelitian ini menunjukkan keluarga yang mampu menyiapkan pasien neuro anestesi dengan baik akan meningkatkan dukungan keluarga. Studi ini memberikan implikasi secara klinis, bagi perawat mempersiapkan keluarga dengan baik, akan berimplikasi pada dukungan keluarga yang baik.

show abstract

“…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 ]. Thus, in these patients, it is quite common among clinicians preferring, at first glance, a conservative treatment, and shift toward surgery only in the case of deterioration in the state of consciousness [ 9 ].…”

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

View full text Add to dashboard Cite

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.

show abstract

Superiority of craniotomy over supportive care for octogenarians and nonagenarians in operable acute traumatic subdural hematoma

Cited by 5 publications

References 37 publications

Has the Timing of the Surgery a Major Role in Influencing Outcome in Elderly Patients with Acute Subdural Hematomas?

Has the Timing of the Surgery a Major Role in Influencing Outcome in Elderly Patients with Acute Subdural Hematomas?

Kesiapan Dan Dukungan Keluarga Sebelum Tindakan Neuro Anestesi Pada Pasien Operasi Bedah Saraf Di Rsud Jawa Tengah

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

Contact Info

Product

Resources

About