OBJECT: Acute subdural hematoma (SDH) is one of the most lethal forms of intracranial injury; several risk factors predictive of a worse outcome have been identified. Emerging research suggests that patients with coagulopathy and intracerebral hemorrhage have a worse outcome than patients without coagulopathy but with intracerebral hemorrhage. The authors sought to determine if such a relationship exists for patients with acute SDH. METHODS: The authors conducted a retrospective analysis of consecutive patients admitted to a neurosciences intensive care unit with acute SDH over a 4-year period (January 1997-December 2001). Demographic data, laboratory values, admission source, prior functional status, medical comorbidities, treatments received, and discharge disposition were recorded, as were scores on the Acute Physiology, Age, and Chronic Health Evaluation III (APACHE III). Coagulopathy was defined as an internal normalized ratio>1.2 or a prothrombin time>or=12.7 seconds. Univariate and multivariate analyses were performed on 244 patients to determine factors associated with worse short-term outcomes. RESULTS: The authors identified 248 patients with acute SDH admitted to the neurointensive care unit during the study period, of which 244 had complete data. Most were male (61%), and the mean age of the study population was 71.3+/-15 years (range 20-95 years). Fifty-three patients (22%) had coagulopathy. The median APACHE III score was 43 (range 11-119). Twenty-nine patients (12%) died in the hospital. Independent predictors of inhospital death included APACHE III score (odds ratio [OR] 4.4, 95% confidence interval [CI] 1.4-13.4, p=0.011) and coagulopathy (OR 2.7, 95% CI 1.1-7.1, p=0.037). Surgical evacuation of acute SDH was associated with reduced inhospital deaths (OR 0.2, 95% CI 0.1-0.6, p=0.003). CONCLUSIONS: Coagulopathy is independently associated with inhospital death in patients with acute SDH. Time to treatment to correct coagulopathy using fresh frozen plasma and/or vitamin K was prolonged.
OBJECT: Acute subdural hematoma (SDH) is one of the most lethal forms of intracranial injury; several risk factors predictive of a worse outcome have been identified. Emerging research suggests that patients with coagulopathy and intracerebral hemorrhage have a worse outcome than patients without coagulopathy but with intracerebral hemorrhage. The authors sought to determine if such a relationship exists for patients with acute SDH. METHODS: The authors conducted a retrospective analysis of consecutive patients admitted to a neurosciences intensive care unit with acute SDH over a 4-year period (January 1997-December 2001). Demographic data, laboratory values, admission source, prior functional status, medical comorbidities, treatments received, and discharge disposition were recorded, as were scores on the Acute Physiology, Age, and Chronic Health Evaluation III (APACHE III). Coagulopathy was defined as an internal normalized ratio>1.2 or a prothrombin time>or=12.7 seconds. Univariate and multivariate analyses were performed on 244 patients to determine factors associated with worse short-term outcomes. RESULTS: The authors identified 248 patients with acute SDH admitted to the neurointensive care unit during the study period, of which 244 had complete data. Most were male (61%), and the mean age of the study population was 71.3+/-15 years (range 20-95 years). Fifty-three patients (22%) had coagulopathy. The median APACHE III score was 43 (range 11-119). Twenty-nine patients (12%) died in the hospital. Independent predictors of inhospital death included APACHE III score (odds ratio [OR] 4.4, 95% confidence interval [CI] 1.4-13.4, p=0.011) and coagulopathy (OR 2.7, 95% CI 1.1-7.1, p=0.037). Surgical evacuation of acute SDH was associated with reduced inhospital deaths (OR 0.2, 95% CI 0.1-0.6, p=0.003). CONCLUSIONS:Coagulopathy is independently associated with inhospital death in patients with acute SDH. Time to treatment to correct coagulopathy using fresh frozen plasma and/or vitamin K was prolonged.
Authors: Timolaos Rizos; Ekkehart Jenetzky; Christian Herweh; Andreas Unterberg; Werner Hacke; Roland Veltkamp Journal: Neurocrit Care Date: 2010-12 Impact factor: 3.210
Authors: Vijay Yanamadala; Brian P Walcott; Peter E Fecci; Peter Rozman; Jay I Kumar; Brian V Nahed; Brooke Swearingen Journal: J Clin Neurosci Date: 2014-06-18 Impact factor: 1.961
Authors: Michael J Souter; Patricia A Blissitt; Sandralee Blosser; Jordan Bonomo; David Greer; Draga Jichici; Dea Mahanes; Evie G Marcolini; Charles Miller; Kiranpal Sangha; Susan Yeager Journal: Neurocrit Care Date: 2015-08 Impact factor: 3.210
Authors: Murtaza Akhter; Andrea Morotti; Abigail Sara Cohen; Yuchiao Chang; Alison M Ayres; Kristin Schwab; Anand Viswanathan; Mahmut Edip Gurol; Christopher David Anderson; Steven Mark Greenberg; Jonathan Rosand; Joshua Norkin Goldstein Journal: Intern Emerg Med Date: 2017-06-01 Impact factor: 3.397
Authors: Christopher Beynon; Steffen Brenner; Alexander Younsi; Timolaos Rizos; Jan-Oliver Neumann; Johannes Pfaff; Andreas W Unterberg Journal: Neurocrit Care Date: 2019-04 Impact factor: 3.210
Authors: David Robinson; Logan Pyle; Brandon Foreman; Laura B Ngwenya; Opeolu Adeoye; Daniel Woo; Natalie Kreitzer Journal: Am J Emerg Med Date: 2021-03-13 Impact factor: 4.093