Gianluca Trevisi1, Carmelo Lucio Sturiale2, Alba Scerrati3,4, Oriela Rustemi5, Luca Ricciardi6, Fabio Raneri5, Alberto Tomatis1, Amedeo Piazza6, Anna Maria Auricchio2, Vito Stifano2, Carmine Romano3, Pasquale De Bonis3,4, Annunziato Mangiola1,7. 1. 1Neurosurgical Unit, Ospedale Santo Spirito, Pescara. 2. 2Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome. 3. 3Department of Neurosurgery, S. Anna University Hospital, Ferrara. 4. 4Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara. 5. 5UOC Neurochirurgia 1, Azienda ULSS 8 Berica Ospedale San Bortolo, Vicenza. 6. 6UOC di Neurochirurgia, Azienda Ospedaliera Sant'Andrea, Dipartimento NESMOS, Sapienza-Roma; and. 7. 7Department of Neurosciences, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy.
Abstract
OBJECTIVE: The objective of this study was to analyze the risk factors associated with the outcome of acute subdural hematoma (ASDH) in elderly patients treated either surgically or nonsurgically. METHODS: The authors performed a retrospective multicentric analysis of clinical and radiological data on patients aged ≥ 70 years who had been consecutively admitted to the neurosurgical department of 5 Italian hospitals for the management of posttraumatic ASDH in a 3-year period. Outcome was measured according to the Glasgow Outcome Scale (GOS) at discharge and at 6 months' follow-up. A GOS score of 1-3 was defined as a poor outcome and a GOS score of 4-5 as a good outcome. Univariate and multivariate statistics were used to determine outcome predictors in the entire study population and in the surgical group. RESULTS: Overall, 213 patients were admitted during the 3-year study period. Outcome was poor in 135 (63%) patients, as 65 (31%) died during their admission, 33 (15%) were in a vegetative state, and 37 (17%) had severe disability at discharge. Surgical patients had worse clinical and radiological findings on arrival or during their admission than the patients undergoing conservative treatment. Surgery was performed in 147 (69%) patients, and 114 (78%) of them had a poor outcome. In stratifying patients by their Glasgow Coma Scale (GCS) score, the authors found that surgery reduced mortality but not the frequency of a poor outcome in the patients with a moderate to severe GCS score. The GCS score and midline shift were the most significant predictors of outcome. Antiplatelet drugs were associated with better outcomes; however, patients taking such medications had a better GCS score and better radiological findings, which could have influenced the former finding. Patients with fixed pupils never had a good outcome. Age and Charlson Comorbidity Index were not associated with outcome. CONCLUSIONS: Traumatic ASDH in the elderly is a severe condition, with the GCS score and midline shift the stronger outcome predictors, while age per se and comorbidities were not associated with outcome. Antithrombotic drugs do not seem to negatively influence pretreatment status or posttreatment outcome. Surgery was performed in patients with a worse clinical and radiological status, reducing the rate of death but not the frequency of a poor outcome.
OBJECTIVE: The objective of this study was to analyze the risk factors associated with the outcome of acute subdural hematoma (ASDH) in elderly patients treated either surgically or nonsurgically. METHODS: The authors performed a retrospective multicentric analysis of clinical and radiological data on patients aged ≥ 70 years who had been consecutively admitted to the neurosurgical department of 5 Italian hospitals for the management of posttraumatic ASDH in a 3-year period. Outcome was measured according to the Glasgow Outcome Scale (GOS) at discharge and at 6 months' follow-up. A GOS score of 1-3 was defined as a poor outcome and a GOS score of 4-5 as a good outcome. Univariate and multivariate statistics were used to determine outcome predictors in the entire study population and in the surgical group. RESULTS: Overall, 213 patients were admitted during the 3-year study period. Outcome was poor in 135 (63%) patients, as 65 (31%) died during their admission, 33 (15%) were in a vegetative state, and 37 (17%) had severe disability at discharge. Surgical patients had worse clinical and radiological findings on arrival or during their admission than the patients undergoing conservative treatment. Surgery was performed in 147 (69%) patients, and 114 (78%) of them had a poor outcome. In stratifying patients by their Glasgow Coma Scale (GCS) score, the authors found that surgery reduced mortality but not the frequency of a poor outcome in the patients with a moderate to severe GCS score. The GCS score and midline shift were the most significant predictors of outcome. Antiplatelet drugs were associated with better outcomes; however, patients taking such medications had a better GCS score and better radiological findings, which could have influenced the former finding. Patients with fixed pupils never had a good outcome. Age and Charlson Comorbidity Index were not associated with outcome. CONCLUSIONS: Traumatic ASDH in the elderly is a severe condition, with the GCS score and midline shift the stronger outcome predictors, while age per se and comorbidities were not associated with outcome. Antithrombotic drugs do not seem to negatively influence pretreatment status or posttreatment outcome. Surgery was performed in patients with a worse clinical and radiological status, reducing the rate of death but not the frequency of a poor outcome.
Entities:
Keywords:
ASDH = acute subdural hematoma; BMT = best medical treatment; CCI = Charlson Comorbidity Index; CSDH = chronic subdural hematoma; DC = decompressive craniectomy; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; acute subdural hematoma; antithrombotic drugs; comorbidity; elderly; surgery; traumatic brain injury
Authors: Susruta Manivannan; Robert Spencer; Omar Marei; Isaac Mayo; Omar Elalfy; John Martin; Malik Zaben Journal: BMJ Open Date: 2021-12-03 Impact factor: 2.692
Authors: Martin Vychopen; Motaz Hamed; Majd Bahna; Attila Racz; Inja Ilic; Abdallah Salemdawod; Matthias Schneider; Felix Lehmann; Lars Eichhorn; Christian Bode; Andreas H Jacobs; Charlotte Behning; Patrick Schuss; Erdem Güresir; Hartmut Vatter; Valeri Borger Journal: Brain Sci Date: 2022-07-26