Jurre Blaauw1,2, Ghislaine A Meelis3, Bram Jacobs1, Niels A van der Gaag4, Korné Jellema5, Kuan H Kho6, Rob J M Groen7, Joukje van der Naalt1, Hester F Lingsma2, Heleen M den Hertog8. 1. Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 2. Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands. 3. Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands. 4. University Neurosurgical Center Holland (UNCH, Leiden University Medical Center, Haaglanden Medical Center & Haga teaching hospital, Leiden & The Hague, The Hague, The Netherlands. 5. Department of Neurology, Haaglanden Medical Centre, The Hague, The Netherlands. 6. Department of Neurosurgery, Medisch Spectrum Twente, Enschede, The Netherlands. 7. Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands. 8. Department of Neurology, Isala Hospital Zwolle, Zwolle, The Netherlands.
Abstract
BACKGROUND: Patients with chronic subdural hematoma (CSDH) can present with a variety of signs and symptoms. The relationship of these signs and symptoms with functional outcome is unknown. Knowledge of these associations might aid clinicians in the choice to initiate treatment and may allow them to better inform patients on expected outcomes. OBJECTIVE: To investigate if presenting signs and symptoms influence functional outcome in patients with CSDH. METHODS: We conducted a retrospective analysis of consecutive CSDH patients in three hospitals. Glasgow Outcome Scale Extended (GOS-E) scores were obtained from the first follow-up visit after treatment. An ordinal multivariable regression analysis was performed, to assess the relationship between the different signs and symptoms on the one hand and functional outcome on the other adjusted for potential confounders. RESULTS: We included 1,307 patients, of whom 958 (73%) were male and mean age was 74 (SD ± 11) years. Cognitive complaints were associated with lower GOS-E scores at follow-up (aOR 0.7, 95% CI: 0.5 - 0.8) Headache and higher Glasgow Coma Scale (GCS) scores were associated with higher GOS-E scores. (aOR 1.9, 95% CI: 1.5-2.3 and aOR 1.3, 95% CI: 1.2-1.4). CONCLUSION: Cognitive complaints are independently associated with worse functional outcome, whereas headache and higher GCS scores are associated with better outcome. The increased probability of unfavorable outcome in patients with CSDH who present with cognitive complaints favors a more prominent place of assessing cognitive status at diagnosis.
BACKGROUND: Patients with chronic subdural hematoma (CSDH) can present with a variety of signs and symptoms. The relationship of these signs and symptoms with functional outcome is unknown. Knowledge of these associations might aid clinicians in the choice to initiate treatment and may allow them to better inform patients on expected outcomes. OBJECTIVE: To investigate if presenting signs and symptoms influence functional outcome in patients with CSDH. METHODS: We conducted a retrospective analysis of consecutive CSDH patients in three hospitals. Glasgow Outcome Scale Extended (GOS-E) scores were obtained from the first follow-up visit after treatment. An ordinal multivariable regression analysis was performed, to assess the relationship between the different signs and symptoms on the one hand and functional outcome on the other adjusted for potential confounders. RESULTS: We included 1,307 patients, of whom 958 (73%) were male and mean age was 74 (SD ± 11) years. Cognitive complaints were associated with lower GOS-E scores at follow-up (aOR 0.7, 95% CI: 0.5 - 0.8) Headache and higher Glasgow Coma Scale (GCS) scores were associated with higher GOS-E scores. (aOR 1.9, 95% CI: 1.5-2.3 and aOR 1.3, 95% CI: 1.2-1.4). CONCLUSION: Cognitive complaints are independently associated with worse functional outcome, whereas headache and higher GCS scores are associated with better outcome. The increased probability of unfavorable outcome in patients with CSDH who present with cognitive complaints favors a more prominent place of assessing cognitive status at diagnosis.