Article
Age-dependent outcome following acute subdural haematoma
Altersabhängiges Outcome nach akutem Subduralhämatom
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Authors
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Sylvia Bele
- Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
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Elisabeth Bründl
- Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
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Karl-Michael Schebesch
- Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
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Alexander Brawanski
- Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
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Nils Ole Schmidt
- Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: With increasing numbers of elderly patients and tight resources concernig intensive care beds we examined the outcome following acute subdural hematoma (aSDH) according to age and initial GCS.
Methods: Charts of patients with aSDH between 2000 and 2017 were retrospectively checked for age, GCS on admission, midline shift, pathological coagulation and GOS at discharge and 6 months after hospital discharge. Only patients who either were treated surgically or at least for 24 h conservatively on an ICU were included. We built 2 age groups, a) patients ≤65 years and b) patients > 65 years. Adverse outcome was defined as GOS 1-3 and good outcome GOS 4-5.
Results: 571 patients were included in this study. 264 patients were ≤65 years and 307 > 65 years. In the younger patients, 163 were GOS 1-3 and 101 were GOS 3-4 at hospital discharge. 6 months later a total of 156 patients ≤ 65 years showed good outcome. In the elderly patient group 244 of 307 were GOS 1-3, 90 patients of whom died during hospital stay. Only 63 elderly patients were in the good outcome group. The patients > 65 years also showed less improvement compared to the younger population as only 98 patients were in the GOS 4-5 group at 6 months after discharge, meaning only 35 patients improved over the months. When combined with primary GCS≤ 5 on admission, 97% of the patients > 65 years were GOS 1-3, 63% of whom died during hospital stay. At 6 months after discharge an additional 15 % died.In the group of patients≤ 65 years and GCS≤ 5 on admission initially 92% were GOS 1-3 at discharge but clearly improved after 6 months with 67% remaining GOS 1-3.
Conclusion: In our examined population, patients > 65 years showed significantly worse outcome following aSDH than younger patients. Especially when the GCS on hopital admission was≤ 5, 63 % of the patients died during hospital stay and 34 % stayed in care centers. Thus, it should be very carefully decided if surgical treatment is the correct choice for patients > 65 years of age with aSDH and GCS≤ 5 on admission since those patietns either die or stay in nursing homes in clinically bad condition.
