Acute subdural hematoma in the elderly; clinical and CT factors influencing the surgical treatment decision.

Acute subdural hematomas (aSDH) are severe traumatic brain injuries. Older patients have a higher mortality rate. In the present study the computed tomography (CT) and neurological deficits caused by aSDH were used as prognostic factors to define the outcome and surgical treatment indication in older patients. The affect of the Glasgow Coma Scale (GCS) score on initial presentation, pupil abnormalities, parenchymal lesions, SDH-thickness, midline shift and intracranial pressure (ICP) in the outcome of older patients (>or=65 years old) admitted to our hospital between 1993 and 2006 with aSDH was evaluated. The outcome was assessed with the Glasgow Outcome Scale (GOS). The data were collected retrospectively. Statistical analysis was performed with Chi-square test and ANOVA. Older patients have a high mortality after aSDH. A low GCS score (3-8), pupil abnormalities, the presence of contusions and subarachnoid bleeding, midline shift>aSDH thickness as well as a highly elevated ICP>40 mmHg are unfavorable factors in the prognosis of aSDH. Patients with a GCS of 13-15 can be observed clinically (the expected outcome is very good). Comatose patients (GCS 3-8) with bilateral dilatation of the pupils should not be operated (very high mortality rate). If the GCS score is <13 and both pupils or only one are reactive to light and the midline shift<10 mm, surgery is indicated. If the midline shift is >10 mm and aSDH thickness>midline shift, surgery is also indicated. If in the same patient group midline shift>SDH thickness and ICP>40 mmHg, surgery is not indicated.

Petridis AK ，Dörner L ，Doukas A ，Eifrig S ，Barth H ，Mehdorn M ... -  《Central European neurosurgery》

Prognostic significance of hematoma thickness to midline shift ratio in patients with acute intracranial subdural hematoma: a retrospective study.

Moussa WMM ，Khedr WM ，Elwany AH 《-》

A simple tool to identify elderly patients with a surgically important acute subdural haematoma.

ASDH in the elderly is a common and increasing problem, and differs in its pathophysiology from ASDH in younger people. Admitting doctors may have difficulty identifying those elderly patients whose lesions may benefit from surgery. The objective of this study was to determine whether simple neuroradiological measurements could identify those patients, who need urgent neurosurgical referral for consideration for surgery. A retrospective cohort study. All patients aged 65 years or greater referred to Salford Royal Foundation Trust with the diagnosis of ASDH between 01/01/2008 and 31/12/2011. The initial presenting CT brain scans were reviewed. The linear dimensions, degree of midline shift and haematoma volume (using ABC/2 method) of all scans were measured and recorded. All presenting radiology was also assessed by a consultant neurosurgeon blind to clinical and CT scan measurement data and patients were categorised as having "surgical" lesions or not. Receiver operating characteristic (ROC) curves were generated and cut point value for 100% sensitivity and specificity were tabled to assess which combination of scan parameters best predicted a "surgical" ASDH. 212/483 patients were considered to have a 'surgical' lesion. All 'surgical' lesions had a volume of >35ml (range 35-435), maximum thickness of ≥10mm (range 10-49) and 99% had midline shift ≥1mm (range 0-32). The best predictor of a 'surgical' lesion was a combination of maximum haematoma thickness and midline shift which offered 100% (95% CI 98.3-100) sensitivity with 83% (95% CI 77.6-87) specificity. Surgically relevant cases of ASDH in the elderly can be reliably and objectively identified by two easily performed scan measurements, haematoma thickness and midline shift. If used in routine practice, these measurements could clarify those patients who may need urgent neurosurgical referral and might avoid unnecessary transfer to neurosurgical units in this cohort.

Evans JA ，Bailey M ，Vail A ，Tyrrell PJ ，Parry-Jones AR ，Patel HC ... -  《-》

Prognosis of isolated acute post-traumatic subdural haematoma.

D'Amato L ，Piazza O ，Alliata L ，Sabia G ，Zito G ，Frassanito L ，Della Corte F ，Tufano R ... -  《Journal of Neurosurgical Sciences》

Significant increase in acute subdural hematoma in octo- and nonagenarians: surgical treatment, functional outcome, and predictors in this patient cohort.

Won SY ，Dubinski D ，Brawanski N ，Strzelczyk A ，Seifert V ，Freiman TM ，Konczalla J ... -  《Neurosurgical Focus》