Krwiak podtwardówkowy – Rokowania, prognozy i postęp choroby

Krwiak podtwardówkowy
Rokowania, prognozy i postęp choroby

Krwiak podtwardówkowy (SDH) charakteryzuje się zróżnicowanym rokowaniem zależnym od wielu czynników klinicznych i obrazowych. Ostry SDH wiąże się z wysoką śmiertelnością, sięgającą 50-90% u pacjentów z wynikiem Glasgow Coma Scale (GCS) ≤8, przy ogólnej śmiertelności około 60% i funkcjonalnym powrocie do zdrowia u 38% chorych. Wiek powyżej 61 lat zwiększa śmiertelność do 73%, a u pacjentów powyżej 80 lat nawet do 88%. Obecność niereaktywnych źrenic (obustronnie 97%, jednostronnie 81%) oraz współistniejące zmiany wewnątrzczaszkowe (krwiak śródmózgowy 91%, krwotok podpajęczynówkowy 87%, stłuczenie mózgu 75%) znacząco pogarszają rokowanie. Po chirurgicznym usunięciu ostrego SDH u osób ≥60 lat śmiertelność wynosi 40% przy wypisie i 49% w długoterminowej obserwacji, a odsetek złych wyników w skali Glasgow Outcome Scale (GOS) sięga 79-81%. Przewlekły SDH, choć wcześniej uważany za łagodny, wykazuje roczną śmiertelność 14,3-15,3% i skumulowane ryzyko nawrotu około 15% w pierwszym roku po zdarzeniu. Współistniejące choroby i cechy pacjenta istotnie wpływają na ryzyko nawrotu i śmiertelność.

Prognostyka krwiaka podtwardówkowego (Subdural haematoma Prognosis)

Wyniki leczenia ostrego krwiaka podtwardówkowego (ASDH)
Wyniki leczenia u osób starszych
Prognostyka przewlekłego krwiaka podtwardówkowego (CSDH)
Systemy oceny prognostycznej
Biomarkery prognostyczne
Wpływ leków przeciwzakrzepowych
Modele uczenia maszynowego w prognostyce
Ograniczenia aktualnych modeli prognostycznych
Czynniki prognostyczne obrazowania

Podsumowanie prognostyki krwiaka podtwardówkowego

Kolejne rozdziały

Prognostyka krwiaka podtwardówkowego (Subdural haematoma Prognosis)

Krwiak podtwardówkowy (Subdural haematoma, SDH) stanowi poważne schorzenie neurologiczne, którego prognostyka zależy od wielu czynników. Przewidywanie wyników leczenia oraz ryzyka nawrotu jest kluczowe dla optymalnego postępowania z pacjentami i planowania dalszej opieki. Poniżej przedstawiono aktualne dane dotyczące prognostyki zarówno ostrego jak i przewlekłego krwiaka podtwardówkowego.¹²

Wyniki leczenia ostrego krwiaka podtwardówkowego (ASDH)

Ostry krwiak podtwardówkowy wiąże się z wysoką śmiertelnością, która waha się od 50% do 90% u pacjentów z wynikiem w skali Glasgow (GCS) wynoszącym 8 lub mniej. Ogólne rokowanie dla pacjentów z ostrym krwiakiem podtwardówkowym pozostaje trudne – mniej niż 25% wszystkich przypadków osiąga pełny powrót do zdrowia bez poważnych deficytów neurologicznych.³

Badania wykazały, że funkcjonalny powrót do zdrowia osiąga około 38% pacjentów, przy śmiertelności wynoszącej 60%. Znaczące różnice zaobserwowano w zależności od początkowego stanu neurologicznego – 91% pacjentów z wysokim wynikiem GCS (9-15) i jedynie 23% pacjentów z niskim GCS (3-8) osiągnęło funkcjonalny powrót do zdrowia.⁴

Kluczowe czynniki prognostyczne w ASDH

Wiek pacjenta: Pacjenci powyżej 61 roku życia mają śmiertelność na poziomie 73%, w porównaniu do 64% u osób w wieku 21-40 lat. W grupie wiekowej poniżej 40 lat śmiertelność wynosi około 20%, w wieku 40-80 lat wzrasta do 65%, a powyżej 80 lat osiąga nawet 88%.⁵⁶
Stan neurologiczny: Wszyscy pacjenci z wynikiem GCS wynoszącym 3 umierają. Śmiertelność u pacjentów z GCS 4-5 wynosi odpowiednio 95% i 75%.⁷
Reakcja źrenic: 97% pacjentów z obustronnie niereaktywnymi źrenicami i 81% pacjentów z jednostronnie niereaktywną źrenicą umiera.⁸
Towarzyszące zmiany wewnątrzczaszkowe: Śmiertelność wynosi 91% przy współistniejącym krwiaku śródmózgowym, 87% przy krwotoku podpajęczynówkowym i 75% przy stłuczeniu mózgu.⁹
Złożoność krwiaka: Prosty ostry krwiak podtwardówkowy (bez uszkodzenia miąższu) stanowi około połowę wszystkich przypadków i wiąże się ze śmiertelnością około 20%. Powikłany krwiak podtwardówkowy (np. z towarzyszącym stłuczeniem lub uszkodzeniem półkuli mózgowej) jest związany ze śmiertelnością około 60%.¹⁰

Badania wskazują, że ciężkość obrażeń i reakcja źrenic są najważniejszymi czynnikami prognostycznymi. Wiek i współistniejące zmiany wewnątrzczaszkowe również mają istotny wpływ na rokowanie.¹¹

Wyniki leczenia u osób starszych

Wyniki po chirurgicznym usunięciu ostrego krwiaka podtwardówkowego u pacjentów w wieku 60 lat i starszych są niekorzystne. Zbiorcza szacunkowa śmiertelność w tej grupie wynosi 40% przy wypisie i 49% w długoterminowej obserwacji. Szacowany odsetek złych wyników w skali Glasgow Outcome Scale (GOS) wynosi 81% przy wypisie i 79% w długoterminowej obserwacji.¹²

Potencjalne czynniki ryzyka złego wyniku obejmują wiek, wyjściowy stan funkcjonalny, przedoperacyjny stan neurologiczny i parametry obrazowania. Jest to najlepszy poziom dowodów w obecnej literaturze, że interwencja chirurgiczna w przypadku ASDH u osób starszych niesie ze sobą znaczące ryzyko, które należy rozważyć w stosunku do potencjalnych korzyści.¹³

Prognostyka przewlekłego krwiaka podtwardówkowego (CSDH)

Przewlekły krwiak podtwardówkowy, wcześniej uważany za stosunkowo łagodny i łatwy w leczeniu, jest obecnie postrzegany jako możliwy sygnał początku klinicznego pogorszenia stanu zdrowia.¹⁴

W długoterminowym badaniu populacyjnym stwierdzono, że podczas okresu obserwacji zmarło 45% pacjentów (3805 osób). Śmiertelność wewnątrzszpitalna wynosiła 0,7% (n=60), a 30-dniowa śmiertelność 4,2% (n=358). Roczna śmiertelność wynosiła 14,3% (95% CI=13,4-15,2%) wśród mężczyzn i 15,3% (95% CI=14,0-16,7%) wśród kobiet.¹⁵

Nadmiarowa śmiertelność

Roczny wskaźnik nadmiarowej śmiertelności w porównaniu z ogólną populacją wynosił 9,1% (95% CI=8,4-9,9) wśród mężczyzn i 10,3% (95% CI=9,1-11,4) wśród kobiet. Najwyższe ryzyko śmiertelności zaobserwowano wśród najmłodszej grupy wiekowej. Ogólna śmiertelność i konieczność ponownych operacji zmniejszyły się w badanym okresie.¹⁶¹⁷

Wyniki badań podkreślają, że choroba jest bardziej niebezpieczna niż wcześniej sądzono i powoduje śmiertelność we wszystkich narażonych grupach wiekowych – nawet niewielkie obciążenie chorobami współistniejącymi może być śmiertelne w okresie pooperacyjnym.¹⁸

Reoperacje i nawroty

Ryzyko nawrotu krwiaka podtwardówkowego jest w dużej mierze ograniczone do pierwszego roku po pierwotnym zdarzeniu. Skumulowane ryzyko nawrotu SDH wynosi około 15% i jest głównie ograniczone do pierwszego roku po pierwotnym zdarzeniu.¹⁹

Choroby współistniejące i inne cechy pacjenta znacząco wpływają na ryzyko nawrotu SDH. Bardzo wysokie ryzyko obserwowane u osób z wybranymi kombinacjami czynników predykcyjnych sugeruje potrzebę bardziej zindywidualizowanych informacji prognostycznych i obserwacji.²⁰

Śmiertelność w ciągu 30 dni od operacji wynosi 3,2-6,5%. Około 80% pacjentów powraca do poziomu funkcjonowania sprzed krwiaka. Korzystne wyniki obserwuje się u 61% pacjentów w wieku 60 lat lub młodszych i u 76% pacjentów powyżej 60 roku życia.²¹

Współczynniki zachorowalności i śmiertelności związane z leczeniem chirurgicznym przewlekłego krwiaka podtwardówkowego szacuje się odpowiednio na 11% i 5%. Między 86% a 90% pacjentów z przewlekłym krwiakiem podtwardówkowym jest odpowiednio leczonych po jednym zabiegu chirurgicznym.²²

Systemy oceny prognostycznej

Skala SHE

Skala Subdural Hematoma in the Elderly (SHE) została opracowana do przewidywania 30-dniowej śmiertelności u pacjentów w podeszłym wieku (65 lat i starszych) z ostrym, przewlekłym lub mieszanym krwiakiem podtwardówkowym po niewielkim urazie lub bez wcześniejszego urazu.²³

30-dniowa śmiertelność stale wzrasta wraz ze wzrostem wyniku SHE dla wszystkich typów krwiaka. Dla pacjentów z ostrym krwiakiem podtwardówkowym 30-dniowa śmiertelność wynosiła 3,2% dla wyniku SHE 0, i wzrastała do 13,1%, 32,7%, 95,7% i 100% odpowiednio dla wyników SHE 1, 2, 3 i 4.²⁴

Skala SHE ma najlepszą zdolność rozróżniającą dla ostrego krwiaka podtwardówkowego, chociaż sprawdza się również w przypadkach przewlekłego i mieszanego krwiaka podtwardówkowego. Po wymaganej zewnętrznej walidacji i ocenie wiarygodności, skala SHE może być cennym narzędziem nie tylko jako ramy do podejmowania decyzji medycznych, ale także do badań klinicznych w SDH.²⁵

Systemy prognostyczne dla CSDH

Opracowano system klasyfikacji CSDH do przewidywania nawrotu pooperacyjnego wymagającego ponownej operacji (RrR) w oparciu o cechy predykcyjne, które można obiektywnie ocenić w momencie pierwszej prezentacji i początkowej operacji.²⁶

Najsilniejszymi predyktorami RrR były izodensyjne lub hiperdensyjne zmiany oraz zmiany laminarne lub rozdzielone, a także pooperacyjna objętość jamy CSDH większa niż 200 ml.²⁷

Zgodnie z prognostycznym systemem klasyfikacji CSDH, u żadnego pacjenta z wynikiem 0 punktów nie wystąpił RrR. RrR zaobserwowano u 6% pacjentów z wynikiem 1-2 punktów, 30% pacjentów z wynikiem 3-4 punktów i 63% pacjentów z wynikiem 5 punktów (tj. maksymalny wynik). Wskaźnik RrR stale wzrastał wraz ze wzrostem wyniku w prognostycznej skali CSDH (P .001).²⁸

Prognostyczny system klasyfikacji CSDH jest stosowanym narzędziem do stratyfikacji ryzyka RrR u pacjentów z CSDH. Standaryzacja oceny pacjentów przy użyciu tego narzędzia może dostarczyć wstępnych indywidualnych informacji prognostycznych dotyczących nawrotu i ponownej operacji.²⁹

Biomarkery prognostyczne

Kilka biomarkerów zostało wskazanych jako niezależne predyktory nawrotu CSDH i/lub funkcjonalnego wyniku pacjenta, w tym krążące produkty degradacji fibrynogenu (FDP), peptyd natriuretyczny typu B (BNP-1) i lipoproteiny o wysokiej gęstości (HDL), a także azot mocznikowy we krwi (BUN) oraz stosunek neutrofilów do limfocytów we krwi (NLR) lub szerokości rozkładu erytrocytów do liczby płytek krwi (RPR).³⁰

Identyfikacja prognostycznych biomarkerów płynów biologicznych w CSDH jest aktywnym obszarem badań, który może zapewnić przyszłe narzędzia, kierujące decyzjami klinicznymi i umożliwiające projektowanie leczenia w oparciu o stratyfikację ryzyka.³¹

Wpływ leków przeciwzakrzepowych

Rodzaj stosowanej terapii przeciwzakrzepowej jest czynnikiem predykcyjnym charakterystyki CSDH, z istotnym związkiem z wielkością CSDH i obecnością przemieszczenia linii środkowej. Jednak GCS nie wykazał statystycznego związku z rodzajem leku przeciwzakrzepowego.³²

Analiza ryzyka względnego wykazała bezpieczniejszy profil dla DOAC (bezpośrednich doustnych antykoagulantów), z niższym ryzykiem rozwoju większego krwiaka (RR 0,887 vs 1,021) i zmniejszoną prawdopodobieństwem przemieszczenia linii środkowej (RR 0,858 vs 0,938), co zostało potwierdzone przez analizę wielkości efektu przy użyciu ilorazów szans.³³

Dla pacjentów z CSDH, DOAC mogą potencjalnie być bezpieczniejszą metodą antykoagulacji w porównaniu z warfaryną, ponieważ wydają się być związane z rozwojem krwiaków o mniejszych rozmiarach i zmniejszonym przemieszczeniem linii środkowej, chociaż nie było istotnej różnicy w GCS między grupami.³⁴

Modele uczenia maszynowego w prognostyce

Badania wykazały potencjał algorytmów uczenia maszynowego w przewidywaniu niekorzystnych wyników przy wypisie wśród pacjentów z CSDH poddawanych operacji przez otwór trepanacyjny.³⁵

Chociaż analiza statystyczna ujawniła związek różnych czynników przedoperacyjnych z rokowaniem czynnościowym po operacji CSDH, zdolność predykcyjna klasycznych metod statystycznych jest ograniczona. Czynniki związane z niekorzystnymi wynikami u pacjentów z CSDH obejmują wiek, otyłość, przedoperacyjny niski wynik w skali Glasgow (GCS), zajęcie obustronne i czynniki radiologiczne, takie jak zanik mózgu w tomografii komputerowej (CT) głowy.³⁶

Kilka badań wykorzystało wielowymiarowe modele regresji do przewidywania wyników funkcjonalnych; jednakże ich zdolności dyskryminacyjne były suboptymalne, z obszarem pod krzywą charakterystyki odbiornika operacyjnego (ROC-AUC) w zakresie od 0,594 do 0,624.³⁷

Wartości ROC-AUC dla wszystkich podejść uczenia maszynowego w wewnętrznym zbiorze kohortowym były wysokie (0,906-0,925). Dodanie wyników badań krwi do potencjalnych predyktorów i wybranie spośród nich istotnych przyczyniło się do zwiększenia wydajności predykcyjnej modeli uczenia maszynowego. Wartości ROC-AUC tych modeli wykazały zadowalającą wydajność, wahającą się od 0,833 do 0,860 w zewnętrznej kohorcie.³⁸

Badania ujawniły, że tło pacjenta, wyniki kliniczne i wyniki badań krwi były użytecznymi predyktorami pooperacyjnego rokowania funkcjonalnego u pacjentów z CSDH.³⁹

Ograniczenia aktualnych modeli prognostycznych

Pomimo opracowania wielu modeli prognostycznych dla wyników po leczeniu przewlekłego krwiaka podtwardówkowego (CSDH) w ostatnich latach, modele te nie są wystarczająco zwalidowane do stosowania w codziennej praktyce klinicznej.⁴⁰⁴¹

Żaden z badanych modeli nie wykazał dobrej wydajności predykcyjnej dla wyników po leczeniu CSDH w analizowanych zbiorach danych. Badania potwierdzają trudność w przewidywaniu wyników po CSDH i podkreślają heterogeniczność pacjentów z CSDH. Konieczne jest opracowanie wysokiej jakości modeli poprzez wykorzystanie ujednoliconych predyktorów i odpowiednich miar wyników oraz odpowiednich strategii modelowania.⁴²⁴³

Model prognostyczny Alforda przewidywał, że 15% pacjentów umrze w ciągu 30 dni, podczas gdy zaobserwowana proporcja w danych wynosiła 4%. Zatem przeszacował on proporcję pacjentów umierających w ciągu 30 dni o 11 punktów procentowych.⁴⁴⁴⁵

Wydajność modeli w retrospektywnej bazie danych została oceniona, i żaden nie wykazał zarówno dobrej zdolności dyskryminacyjnej, jak i kalibracji w analizowanych danych. Najbardziej prawdopodobne wyjaśnienia wydajności predykcyjnej modeli w danych dotyczą suboptymalnych strategii modelowania i różnic w populacjach badanych.⁴⁶⁴⁷

Czynniki prognostyczne obrazowania

Wyniki badań obrazowych tomografii komputerowej (CT) lub rezonansu magnetycznego (MRI) mogą pomóc wskazać rokowanie. Takie wyniki mogą obejmować: grubość lub objętość krwiaka, stopień przesunięcia linii środkowej, obecność towarzyszących urazowych zmian wewnątrzmiąższowych, ucisk pnia mózgu lub zbiorników podstawy.⁴⁸

Ogólnie rzecz biorąc, zły przedoperacyjny stan neurologiczny może być zwiastunem złego wyniku. Sugerowane czynniki prognostyczne związane z przewlekłym krwiakiem podtwardówkowym obejmują wynik GCS przy przyjęciu, cechy radiograficzne (np. przesunięcie linii środkowej i błony nowe), rodzaj interwencji chirurgicznej.⁴⁹

Podsumowanie prognostyki krwiaka podtwardówkowego

Prognostyka krwiaka podtwardówkowego jest złożona i zależy od wielu czynników, w tym wieku pacjenta, stanu neurologicznego, obecności chorób współistniejących oraz charakterystyki samego krwiaka. Dokładna ocena tych czynników może pomóc w przewidywaniu wyników i optymalizacji leczenia.

Chociaż opracowano różne systemy oceny i modele prognostyczne, wciąż istnieje potrzeba ich dalszej walidacji i udoskonalania. Nowe podejścia, takie jak wykorzystanie biomarkerów i algorytmów uczenia maszynowego, mogą przyczynić się do poprawy dokładności prognostycznej w przyszłości.⁵⁰⁵¹

Zrozumienie czynników prognostycznych ma kluczowe znaczenie dla podejmowania decyzji klinicznych, informowania pacjentów i ich rodzin o możliwych wynikach oraz optymalizacji strategii leczenia dla pacjentów z krwiakiem podtwardówkowym.⁵²

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Materiały źródłowe

#1 Acute subdural hematoma: outcome and outcome prediction – PubMed
https://pubmed.ncbi.nlm.nih.gov/9457718/
Patients with traumatic acute subdural hematoma were studied to determine the factors influencing outcome. […] Functional recovery was achieved in 38% of patients and the mortality was 60%. […] 91% of patients with a high Glasgow Coma Scale (GCS) score (9-15) and 23% of patients with a low GCS score (3-8) achieved functional recovery. […] All of 14 patients with a GCS score of 3 died. […] The mortality of patients with GCS scores of 4 and 5 was 95% to 75%, respectively. […] Patients over 61 years old had a mortality of 73% compared to 64% mortality for those aged 21-40 years. […] 97% of patients with bilateral unreactive pupil and 81% of patients with unilateral unreactive pupil died. […] The mortality rates of associated intracranial lesions were 91% in intracerebral hematoma, 87% in subarachnoid hemorrhage, 75% in contusion. […] Age and associated intracranial lesions were related to outcome. […] Severity of injury and pupillary response were the most important factors for predicting outcome.
#2 Development of machine learning models for predicting unfavorable functional outcomes from preoperative data in patients with chronic subdural hematomas | Scientific Reports
https://www.nature.com/articles/s41598-023-44029-2
This study aimed to predict the functional prognosis in patients with CSDH before undergoing burr hole surgery by employing various machine learning algorithms and utilizing preoperative blood test results and clinical findings as inputs. The practicality and applicability of these predictive models in real-world clinical settings were assessed by performing internal and external validations. […] This study showed that postoperative functional outcome at hospital discharge can be efficiently predicted in patients with CSDH. Although surgical intervention is the primary treatment for most patients with CSDH, some patients require prolonged rehabilitation or transfer to nursing-care facilities and some even experience mortality even after the successful evacuation of hematomas. The frequency of patients with CSDH experiencing these unfavorable outcomes is increasing. Thus, an early indication of postoperative functional status is helpful for health workers in deciding treatment, rehabilitation programs, and the most appropriate discharge destinations for patients with CSDH. Therefore, the accurately prediction of prognosis based on the preoperative information has great clinical value.
#3 Subdural Hematoma: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/1137207-overview
Acute SDH is associated with high mortality rates, ranging from 50% to 90% in patients presenting with Glasgow Coma Scale (GCS) scores of 8 or less. The overall prognosis for patients with acute SDH remains challenging, with fewer than 25% of all cases achieving full recovery without major neurological deficits. […] Several series have shown an increase in favorable outcome in younger patients. Age younger than 40 years was associated with a mortality rate of 20%, whereas age 40-80 years was associated with a mortality rate of 65%. Age older than 80 years carried a mortality rate of 88%. […] Ultimate prognosis is related to the amount of associated direct brain damage and the damage resulting from the mass effect of the hematoma. Simple acute SDH (ie, without parenchymal injury) accounts for about half of all cases and is associated with a mortality rate of about 20%. Complicated SDH (eg, with accompanying contusion or laceration of a cerebral hemisphere) is associated with a mortality rate of about 60%.
#4 Acute subdural hematoma: outcome and outcome prediction – PubMed
https://pubmed.ncbi.nlm.nih.gov/9457718/
Patients with traumatic acute subdural hematoma were studied to determine the factors influencing outcome. […] Functional recovery was achieved in 38% of patients and the mortality was 60%. […] 91% of patients with a high Glasgow Coma Scale (GCS) score (9-15) and 23% of patients with a low GCS score (3-8) achieved functional recovery. […] All of 14 patients with a GCS score of 3 died. […] The mortality of patients with GCS scores of 4 and 5 was 95% to 75%, respectively. […] Patients over 61 years old had a mortality of 73% compared to 64% mortality for those aged 21-40 years. […] 97% of patients with bilateral unreactive pupil and 81% of patients with unilateral unreactive pupil died. […] The mortality rates of associated intracranial lesions were 91% in intracerebral hematoma, 87% in subarachnoid hemorrhage, 75% in contusion. […] Age and associated intracranial lesions were related to outcome. […] Severity of injury and pupillary response were the most important factors for predicting outcome.
#5 Acute subdural hematoma: outcome and outcome prediction – PubMed
https://pubmed.ncbi.nlm.nih.gov/9457718/
Patients with traumatic acute subdural hematoma were studied to determine the factors influencing outcome. […] Functional recovery was achieved in 38% of patients and the mortality was 60%. […] 91% of patients with a high Glasgow Coma Scale (GCS) score (9-15) and 23% of patients with a low GCS score (3-8) achieved functional recovery. […] All of 14 patients with a GCS score of 3 died. […] The mortality of patients with GCS scores of 4 and 5 was 95% to 75%, respectively. […] Patients over 61 years old had a mortality of 73% compared to 64% mortality for those aged 21-40 years. […] 97% of patients with bilateral unreactive pupil and 81% of patients with unilateral unreactive pupil died. […] The mortality rates of associated intracranial lesions were 91% in intracerebral hematoma, 87% in subarachnoid hemorrhage, 75% in contusion. […] Age and associated intracranial lesions were related to outcome. […] Severity of injury and pupillary response were the most important factors for predicting outcome.
#6 Subdural Hematoma: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/1137207-overview
Acute SDH is associated with high mortality rates, ranging from 50% to 90% in patients presenting with Glasgow Coma Scale (GCS) scores of 8 or less. The overall prognosis for patients with acute SDH remains challenging, with fewer than 25% of all cases achieving full recovery without major neurological deficits. […] Several series have shown an increase in favorable outcome in younger patients. Age younger than 40 years was associated with a mortality rate of 20%, whereas age 40-80 years was associated with a mortality rate of 65%. Age older than 80 years carried a mortality rate of 88%. […] Ultimate prognosis is related to the amount of associated direct brain damage and the damage resulting from the mass effect of the hematoma. Simple acute SDH (ie, without parenchymal injury) accounts for about half of all cases and is associated with a mortality rate of about 20%. Complicated SDH (eg, with accompanying contusion or laceration of a cerebral hemisphere) is associated with a mortality rate of about 60%.
#7 Acute subdural hematoma: outcome and outcome prediction – PubMed
https://pubmed.ncbi.nlm.nih.gov/9457718/
Patients with traumatic acute subdural hematoma were studied to determine the factors influencing outcome. […] Functional recovery was achieved in 38% of patients and the mortality was 60%. […] 91% of patients with a high Glasgow Coma Scale (GCS) score (9-15) and 23% of patients with a low GCS score (3-8) achieved functional recovery. […] All of 14 patients with a GCS score of 3 died. […] The mortality of patients with GCS scores of 4 and 5 was 95% to 75%, respectively. […] Patients over 61 years old had a mortality of 73% compared to 64% mortality for those aged 21-40 years. […] 97% of patients with bilateral unreactive pupil and 81% of patients with unilateral unreactive pupil died. […] The mortality rates of associated intracranial lesions were 91% in intracerebral hematoma, 87% in subarachnoid hemorrhage, 75% in contusion. […] Age and associated intracranial lesions were related to outcome. […] Severity of injury and pupillary response were the most important factors for predicting outcome.
#8 Acute subdural hematoma: outcome and outcome prediction – PubMed
https://pubmed.ncbi.nlm.nih.gov/9457718/
Patients with traumatic acute subdural hematoma were studied to determine the factors influencing outcome. […] Functional recovery was achieved in 38% of patients and the mortality was 60%. […] 91% of patients with a high Glasgow Coma Scale (GCS) score (9-15) and 23% of patients with a low GCS score (3-8) achieved functional recovery. […] All of 14 patients with a GCS score of 3 died. […] The mortality of patients with GCS scores of 4 and 5 was 95% to 75%, respectively. […] Patients over 61 years old had a mortality of 73% compared to 64% mortality for those aged 21-40 years. […] 97% of patients with bilateral unreactive pupil and 81% of patients with unilateral unreactive pupil died. […] The mortality rates of associated intracranial lesions were 91% in intracerebral hematoma, 87% in subarachnoid hemorrhage, 75% in contusion. […] Age and associated intracranial lesions were related to outcome. […] Severity of injury and pupillary response were the most important factors for predicting outcome.
#9 Acute subdural hematoma: outcome and outcome prediction – PubMed
https://pubmed.ncbi.nlm.nih.gov/9457718/
Patients with traumatic acute subdural hematoma were studied to determine the factors influencing outcome. […] Functional recovery was achieved in 38% of patients and the mortality was 60%. […] 91% of patients with a high Glasgow Coma Scale (GCS) score (9-15) and 23% of patients with a low GCS score (3-8) achieved functional recovery. […] All of 14 patients with a GCS score of 3 died. […] The mortality of patients with GCS scores of 4 and 5 was 95% to 75%, respectively. […] Patients over 61 years old had a mortality of 73% compared to 64% mortality for those aged 21-40 years. […] 97% of patients with bilateral unreactive pupil and 81% of patients with unilateral unreactive pupil died. […] The mortality rates of associated intracranial lesions were 91% in intracerebral hematoma, 87% in subarachnoid hemorrhage, 75% in contusion. […] Age and associated intracranial lesions were related to outcome. […] Severity of injury and pupillary response were the most important factors for predicting outcome.
#10 Subdural Hematoma: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/1137207-overview
Acute SDH is associated with high mortality rates, ranging from 50% to 90% in patients presenting with Glasgow Coma Scale (GCS) scores of 8 or less. The overall prognosis for patients with acute SDH remains challenging, with fewer than 25% of all cases achieving full recovery without major neurological deficits. […] Several series have shown an increase in favorable outcome in younger patients. Age younger than 40 years was associated with a mortality rate of 20%, whereas age 40-80 years was associated with a mortality rate of 65%. Age older than 80 years carried a mortality rate of 88%. […] Ultimate prognosis is related to the amount of associated direct brain damage and the damage resulting from the mass effect of the hematoma. Simple acute SDH (ie, without parenchymal injury) accounts for about half of all cases and is associated with a mortality rate of about 20%. Complicated SDH (eg, with accompanying contusion or laceration of a cerebral hemisphere) is associated with a mortality rate of about 60%.
#11 Acute subdural hematoma: outcome and outcome prediction – PubMed
https://pubmed.ncbi.nlm.nih.gov/9457718/
Patients with traumatic acute subdural hematoma were studied to determine the factors influencing outcome. […] Functional recovery was achieved in 38% of patients and the mortality was 60%. […] 91% of patients with a high Glasgow Coma Scale (GCS) score (9-15) and 23% of patients with a low GCS score (3-8) achieved functional recovery. […] All of 14 patients with a GCS score of 3 died. […] The mortality of patients with GCS scores of 4 and 5 was 95% to 75%, respectively. […] Patients over 61 years old had a mortality of 73% compared to 64% mortality for those aged 21-40 years. […] 97% of patients with bilateral unreactive pupil and 81% of patients with unilateral unreactive pupil died. […] The mortality rates of associated intracranial lesions were 91% in intracerebral hematoma, 87% in subarachnoid hemorrhage, 75% in contusion. […] Age and associated intracranial lesions were related to outcome. […] Severity of injury and pupillary response were the most important factors for predicting outcome.
#12 Acute subdural haematoma in the elderly: to operate or not to operate? A systematic review and meta-analysis of outcomes following surgery | BMJ Open
https://bmjopen.bmj.com/content/11/12/e050786
Outcomes following surgical evacuation of ASDH in patients aged 60 years and above are poor. […] Pooled estimated mortality rates in this group are 40% at discharge and 49% at LTFU. […] Estimated rates of poor GOS are 81% at discharge and 79% at LTFU. […] Potential risk factors for poor outcome include age, baseline functional status, preoperative neurological status and imaging parameters. […] This constitutes the best level of evidence in the current literature that surgical intervention for ASDH in the elderly carries significant risks, which must be weighed against benefits.
#13 Acute subdural haematoma in the elderly: to operate or not to operate? A systematic review and meta-analysis of outcomes following surgery | BMJ Open
https://bmjopen.bmj.com/content/11/12/e050786
Outcomes following surgical evacuation of ASDH in patients aged 60 years and above are poor. […] Pooled estimated mortality rates in this group are 40% at discharge and 49% at LTFU. […] Estimated rates of poor GOS are 81% at discharge and 79% at LTFU. […] Potential risk factors for poor outcome include age, baseline functional status, preoperative neurological status and imaging parameters. […] This constitutes the best level of evidence in the current literature that surgical intervention for ASDH in the elderly carries significant risks, which must be weighed against benefits.
#14 Prognosis of patients with operated chronic subdural hematoma | Scientific Reports
https://www.nature.com/articles/s41598-022-10992-5
Chronic subdural hematoma (cSDH), previously considered fairly benign and easy to treat, is now viewed a possible sign of incipient clinical decline. […] During the follow-up, 3805 (45%) patients died. In-hospital case-fatality was 0.7% (n=60) and 30-day case-fatality 4.2% (n=358). The 1-year case-fatality was 14.3% (95% CI=13.4-15.2%) among men and 15.3% (95% CI=14.0-16.7%) among women. […] One-year excess fatality rate compared to general Finnish population was 9.1% (95% CI=8.4-9.9) among men and 10.3% (95% CI=9.1-11.4) among women. […] The overall case-fatality and need for reoperations declined during the study era. […] Our findings underpin the perception that the disease is more dangerous than previously thought and causes mortality in all exposed age groups: even a minor burden of comorbidities can be fatal in the post-operative period.
#15 Prognosis of patients with operated chronic subdural hematoma | Scientific Reports
https://www.nature.com/articles/s41598-022-10992-5
Chronic subdural hematoma (cSDH), previously considered fairly benign and easy to treat, is now viewed a possible sign of incipient clinical decline. […] During the follow-up, 3805 (45%) patients died. In-hospital case-fatality was 0.7% (n=60) and 30-day case-fatality 4.2% (n=358). The 1-year case-fatality was 14.3% (95% CI=13.4-15.2%) among men and 15.3% (95% CI=14.0-16.7%) among women. […] One-year excess fatality rate compared to general Finnish population was 9.1% (95% CI=8.4-9.9) among men and 10.3% (95% CI=9.1-11.4) among women. […] The overall case-fatality and need for reoperations declined during the study era. […] Our findings underpin the perception that the disease is more dangerous than previously thought and causes mortality in all exposed age groups: even a minor burden of comorbidities can be fatal in the post-operative period.
#16 Prognosis of patients with operated chronic subdural hematoma | Scientific Reports
https://www.nature.com/articles/s41598-022-10992-5
Chronic subdural hematoma (cSDH), previously considered fairly benign and easy to treat, is now viewed a possible sign of incipient clinical decline. […] During the follow-up, 3805 (45%) patients died. In-hospital case-fatality was 0.7% (n=60) and 30-day case-fatality 4.2% (n=358). The 1-year case-fatality was 14.3% (95% CI=13.4-15.2%) among men and 15.3% (95% CI=14.0-16.7%) among women. […] One-year excess fatality rate compared to general Finnish population was 9.1% (95% CI=8.4-9.9) among men and 10.3% (95% CI=9.1-11.4) among women. […] The overall case-fatality and need for reoperations declined during the study era. […] Our findings underpin the perception that the disease is more dangerous than previously thought and causes mortality in all exposed age groups: even a minor burden of comorbidities can be fatal in the post-operative period.
#17 Prognosis of patients with operated chronic subdural hematoma | Scientific Reports
https://www.nature.com/articles/s41598-022-10992-5
The main findings of this nationwide study are that after operated cSDH (i) the 1-year case-fatality was about 15%the highest case-fatality rates were observed in the oldest age group, (ii) comorbidities drastically increase fatality, (iii) one-year excess fatality rate compared to the general population was about 10%the highest risk for fatality was observed among the youngest age group, (iv) older age but not comorbidities increase the risk for reoperations, and (v) case-fatality and the need for reoperations is declining in Finland over time. […] cSDH can lead to death even in young individuals who have comorbidities, and higher age is significantly associated with both reoperations and mortality. Moreover, cSDH causes substantial excess fatality in all age groups.
#18 Prognosis of patients with operated chronic subdural hematoma | Scientific Reports
https://www.nature.com/articles/s41598-022-10992-5
Chronic subdural hematoma (cSDH), previously considered fairly benign and easy to treat, is now viewed a possible sign of incipient clinical decline. […] During the follow-up, 3805 (45%) patients died. In-hospital case-fatality was 0.7% (n=60) and 30-day case-fatality 4.2% (n=358). The 1-year case-fatality was 14.3% (95% CI=13.4-15.2%) among men and 15.3% (95% CI=14.0-16.7%) among women. […] One-year excess fatality rate compared to general Finnish population was 9.1% (95% CI=8.4-9.9) among men and 10.3% (95% CI=9.1-11.4) among women. […] The overall case-fatality and need for reoperations declined during the study era. […] Our findings underpin the perception that the disease is more dangerous than previously thought and causes mortality in all exposed age groups: even a minor burden of comorbidities can be fatal in the post-operative period.
#19 Recurrence of Subdural Haematoma in a Population-Based Cohort â Risks and Predictive Factors | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0140450
The recurrence risk of subdural hematoma is largely limited to the first year. Patient characteristics including co-morbidities greatly influence the recurrence risk of SDH, suggesting that individualized prognostic guidance and follow-up is needed. […] The cumulative risk of a recurrent SDH was found to be 15% and largely limited to the first year after the primary event. Co-morbidities and other patient characteristics greatly influence the recurrence risk of SDH. The very high risks observed for individuals with selected combinations of predictors suggest more individualised prognostic information and follow-up.
#20 Recurrence of Subdural Haematoma in a Population-Based Cohort â Risks and Predictive Factors | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0140450
The recurrence risk of subdural hematoma is largely limited to the first year. Patient characteristics including co-morbidities greatly influence the recurrence risk of SDH, suggesting that individualized prognostic guidance and follow-up is needed. […] The cumulative risk of a recurrent SDH was found to be 15% and largely limited to the first year after the primary event. Co-morbidities and other patient characteristics greatly influence the recurrence risk of SDH. The very high risks observed for individuals with selected combinations of predictors suggest more individualised prognostic information and follow-up.
#21 Subdural Hematoma: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/1137207-overview
Findings on CT scan or MRI may help indicate prognosis. Such findings may include the following: thickness or volume of the hematoma, degree of midline shift, presence of associated traumatic intraparenchymal lesions, compression of the brainstem or basal cisterns. […] In general, a poor preoperative neurologic status may be a harbinger of a poor outcome. […] Suggested prognostic factors associated with chronic SDH include admission GCS score, radiographic features (eg, midline shift and neomembranes), type of surgical intervention. […] The mortality within 30 days of surgery is 3.2-6.5%. Eighty percent of patients resume their prehematoma level of function. Sixty-one percent of patients aged 60 years or younger and in 76% of patients older than 60 years have favorable outcomes. […] The morbidity and mortality rates associated with surgical treatment of chronic SDH have been estimated at 11% and 5%, respectively. Between 86% and 90% of patients with chronic SDH are adequately treated after one surgical procedure.
#22 Subdural Hematoma: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/1137207-overview
Findings on CT scan or MRI may help indicate prognosis. Such findings may include the following: thickness or volume of the hematoma, degree of midline shift, presence of associated traumatic intraparenchymal lesions, compression of the brainstem or basal cisterns. […] In general, a poor preoperative neurologic status may be a harbinger of a poor outcome. […] Suggested prognostic factors associated with chronic SDH include admission GCS score, radiographic features (eg, midline shift and neomembranes), type of surgical intervention. […] The mortality within 30 days of surgery is 3.2-6.5%. Eighty percent of patients resume their prehematoma level of function. Sixty-one percent of patients aged 60 years or younger and in 76% of patients older than 60 years have favorable outcomes. […] The morbidity and mortality rates associated with surgical treatment of chronic SDH have been estimated at 11% and 5%, respectively. Between 86% and 90% of patients with chronic SDH are adequately treated after one surgical procedure.
#23 Development of the Subdural Hematoma in the Elderly (SHE) score to predict mortality in: Journal of Neurosurgery Volume 132 Issue 5 (2019) Journals
https://thejns.org/view/journals/j-neurosurg/132/5/article-p1616.xml
The purpose of this study was to describe the development of a novel prognostic score, the Subdural Hematoma in the Elderly (SHE) score. The SHE score is intended to predict 30-day mortality in elderly patients (those 65 years of age) with an acute, chronic, or mixed-density subdural hematoma (SDH) after minor, or no, prior trauma. […] The 30-day mortality rate steadily increased as the SHE score increased for all SDH acuities. For patients with an acute SDH, the 30-day mortality rate was 3.2% for SHE score of 0, and the rate increased to 13.1%, 32.7%, 95.7%, and 100% for SHE scores of 1, 2, 3, and 4, respectively. […] The SHE score is a simple clinical grading scale that accurately stratifies patients risk of mortality based on age, admission GCS score, and SDH volume. Use of the SHE score could improve counseling of patients and their families, allow for standardization of clinical treatment protocols, and facilitate clinical research studies in SDH.
#24 Development of the Subdural Hematoma in the Elderly (SHE) score to predict mortality in: Journal of Neurosurgery Volume 132 Issue 5 (2019) Journals
https://thejns.org/view/journals/j-neurosurg/132/5/article-p1616.xml
The purpose of this study was to describe the development of a novel prognostic score, the Subdural Hematoma in the Elderly (SHE) score. The SHE score is intended to predict 30-day mortality in elderly patients (those 65 years of age) with an acute, chronic, or mixed-density subdural hematoma (SDH) after minor, or no, prior trauma. […] The 30-day mortality rate steadily increased as the SHE score increased for all SDH acuities. For patients with an acute SDH, the 30-day mortality rate was 3.2% for SHE score of 0, and the rate increased to 13.1%, 32.7%, 95.7%, and 100% for SHE scores of 1, 2, 3, and 4, respectively. […] The SHE score is a simple clinical grading scale that accurately stratifies patients risk of mortality based on age, admission GCS score, and SDH volume. Use of the SHE score could improve counseling of patients and their families, allow for standardization of clinical treatment protocols, and facilitate clinical research studies in SDH.
#25 Development of the Subdural Hematoma in the Elderly (SHE) score to predict mortality in: Journal of Neurosurgery Volume 132 Issue 5 (2019) Journals
https://thejns.org/view/journals/j-neurosurg/132/5/article-p1616.xml
The SHE score has the best discriminative ability for acute SDH, although it also performed well in cases of chronic and mixed-density SDH. Following requisite external validation and evaluation of reliability, the SHE score may be a valuable tool not only as a framework for medical decision-making but also for clinical research in SDH.
#26
https://journals.lww.com/neurosurgery/fulltext/2017/11000/a_reliable_grading_system_for_prediction_of.14.aspx
There is no widely adopted grading system for the prediction of postoperative recurrence requiring reoperation (RrR) in patients with chronic subdural hematoma (CSDH). […] We developed a CSDH grading system to predict RrR based on predictive characteristics that can be objectively assessed at the time of first presentation and initial surgery. […] The strongest predictors of RrR were an isodense or hyperdense lesions and laminar or separated lesions, and a postoperative CSDH cavity volume greater than 200 mL. […] According to the prognostic CSDH grading system, no patients with a score of 0 points had RrR. RrR was observed in 6% of patients with a score of 1 to 2 points, 30% of patients with a score of 3 to 4 points, and 63% of patients with a score of 5 points (ie, the maximum score). The rate of RrR increased steadily with increases in the prognostic CSDH grading score (P .001).
#27
https://journals.lww.com/neurosurgery/fulltext/2017/11000/a_reliable_grading_system_for_prediction_of.14.aspx
There is no widely adopted grading system for the prediction of postoperative recurrence requiring reoperation (RrR) in patients with chronic subdural hematoma (CSDH). […] We developed a CSDH grading system to predict RrR based on predictive characteristics that can be objectively assessed at the time of first presentation and initial surgery. […] The strongest predictors of RrR were an isodense or hyperdense lesions and laminar or separated lesions, and a postoperative CSDH cavity volume greater than 200 mL. […] According to the prognostic CSDH grading system, no patients with a score of 0 points had RrR. RrR was observed in 6% of patients with a score of 1 to 2 points, 30% of patients with a score of 3 to 4 points, and 63% of patients with a score of 5 points (ie, the maximum score). The rate of RrR increased steadily with increases in the prognostic CSDH grading score (P .001).
#28
https://journals.lww.com/neurosurgery/fulltext/2017/11000/a_reliable_grading_system_for_prediction_of.14.aspx
There is no widely adopted grading system for the prediction of postoperative recurrence requiring reoperation (RrR) in patients with chronic subdural hematoma (CSDH). […] We developed a CSDH grading system to predict RrR based on predictive characteristics that can be objectively assessed at the time of first presentation and initial surgery. […] The strongest predictors of RrR were an isodense or hyperdense lesions and laminar or separated lesions, and a postoperative CSDH cavity volume greater than 200 mL. […] According to the prognostic CSDH grading system, no patients with a score of 0 points had RrR. RrR was observed in 6% of patients with a score of 1 to 2 points, 30% of patients with a score of 3 to 4 points, and 63% of patients with a score of 5 points (ie, the maximum score). The rate of RrR increased steadily with increases in the prognostic CSDH grading score (P .001).
#29
https://journals.lww.com/neurosurgery/fulltext/2017/11000/a_reliable_grading_system_for_prediction_of.14.aspx
The prognostic CSDH grading system is an applicable tool for RrR risk stratification in patients with CSDH. […] The grading system was then applied to the same set of patients in our database to internally validate its predictive power, and the results are presented in Table 4. The estimated rate of postoperative RrR with 95% CI for groups of patients with different total score points on the grading system gave an internal validation measure. Thus, an increase in the prognostic CSDH grading score was associated with a progressive increase in RrR (P .001 for trend; Table 4). […] The prognostic CSDH grading system has been simplified into a reliable clinical grading scale, which may serve several valuable purposes. Thus, standardization of patient assessments using this tool may provide initial individual prognostic information regarding recurrence and reoperation in patients treated with this surgical strategy, which is important to assess surgery benefits and risks and to provide patients and families with such information. […] Combining subcomponents in the prognostic grading system is a powerful and applicable tool for postoperative RrR risk stratification in patients with CSDH.
#30 Biofluid Biomarkers in the Prognosis of Chronic Subdural Hematoma: A Systematic Scoping Review
https://www.mdpi.com/2075-4418/13/14/2449
The present systematic scoping review aimed at mapping and analyzing the available literature on biological fluid (biofluid) biomarkers showing promise in the prediction of chronic subdural hematoma (cSDH) recurrence and the prognosis of neurological/functional patient outcome. […] Several biomarkers were indicated as independent predictors of cSDH recurrence and/or functional outcome, including circulating fibrinogen degradation products (FDP), brain natriuretic peptide (BNP-1) and high-density lipoprotein (HDL), as well as blood urea nitrogen (BUN) and the ratios of blood neutrophil to lymphocyte (NLR) or red blood cell distribution width to platelet count (RPR). […] The identification of prognostic biofluid biomarkers in cSDH is an active field of research that may provide future tools, guiding clinical decisions and allowing for the design of treatments based on risk stratification.
#31 Biofluid Biomarkers in the Prognosis of Chronic Subdural Hematoma: A Systematic Scoping Review
https://www.mdpi.com/2075-4418/13/14/2449
The present systematic scoping review aimed at mapping and analyzing the available literature on biological fluid (biofluid) biomarkers showing promise in the prediction of chronic subdural hematoma (cSDH) recurrence and the prognosis of neurological/functional patient outcome. […] Several biomarkers were indicated as independent predictors of cSDH recurrence and/or functional outcome, including circulating fibrinogen degradation products (FDP), brain natriuretic peptide (BNP-1) and high-density lipoprotein (HDL), as well as blood urea nitrogen (BUN) and the ratios of blood neutrophil to lymphocyte (NLR) or red blood cell distribution width to platelet count (RPR). […] The identification of prognostic biofluid biomarkers in cSDH is an active field of research that may provide future tools, guiding clinical decisions and allowing for the design of treatments based on risk stratification.
#32 Characteristics of chronic subdural haematomas related to DOACs vs warfarin | BMC Neurology | Full Text
https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-025-04134-3
The type of antithrombotic therapy used was found to be a predictor of CSDH characteristics in this study, with a significant association with the size of the CSDH and the presence of midline shift. However, GCS was not found to be statistically associated with the type of antithrombotic drug. […] Our study is the first and largest to show that warfarin usage is likely to result in a larger volume haematoma in the specific context of CSDHs, when compared to DOACs. […] This is particularly relevant for an ageing population with multi-comorbidities on increasing amounts of anticoagulation medication.
#33 Characteristics of chronic subdural haematomas related to DOACs vs warfarin | BMC Neurology | Full Text
https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-025-04134-3
The aim of this study was to investigate the effects of anticoagulation with DOACs and warfarin on the characteristics of chronic subdural hematomas (CSDHs), specifically, the size of the hematomas, the presence of midline shift and the effect on consciousness levels, measured via the Glasgow Coma Scale (GCS). […] There were statistically significant associations between the type of antithrombotic medication and both midline shift and size of the CSDH (p0.0001), but not GCS (p=0.1956). […] Relative risk analysis revealed a safer profile for DOACs, with a lower risk of developing a larger sized hematoma (RR 0.887 v 1.021) and a reduced likelihood of midline shift (RR 0.858 VS 0.938), which was supported by effect size analysis using odds ratios. […] For CSDH patients, DOACs may potentially be a safer method of anticoagulation as opposed to warfarin as they appear to be linked to the development of smaller sized hematomas and reduced midline shift, although there was no significant difference in GCS between the groups.
#34 Characteristics of chronic subdural haematomas related to DOACs vs warfarin | BMC Neurology | Full Text
https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-025-04134-3
The aim of this study was to investigate the effects of anticoagulation with DOACs and warfarin on the characteristics of chronic subdural hematomas (CSDHs), specifically, the size of the hematomas, the presence of midline shift and the effect on consciousness levels, measured via the Glasgow Coma Scale (GCS). […] There were statistically significant associations between the type of antithrombotic medication and both midline shift and size of the CSDH (p0.0001), but not GCS (p=0.1956). […] Relative risk analysis revealed a safer profile for DOACs, with a lower risk of developing a larger sized hematoma (RR 0.887 v 1.021) and a reduced likelihood of midline shift (RR 0.858 VS 0.938), which was supported by effect size analysis using odds ratios. […] For CSDH patients, DOACs may potentially be a safer method of anticoagulation as opposed to warfarin as they appear to be linked to the development of smaller sized hematomas and reduced midline shift, although there was no significant difference in GCS between the groups.
#35 Development of machine learning models for predicting unfavorable functional outcomes from preoperative data in patients with chronic subdural hematomas | Scientific Reports
https://www.nature.com/articles/s41598-023-44029-2
Chronic subdural hematoma (CSDH) often causes neurological deterioration and is treated with hematoma evacuation. This study aimed to assess the feasibility of various machine learning models to preoperatively predict the functional outcome of patients with CSDH. The poor functional outcome was defined as a modified Rankin scale score of 36 upon hospital discharge. The unfavorable outcome was predicted using four machine learning algorithms on an internal held-out cohort (n=188): logistic regression, support vector machine (SVM), random forest, and light gradient boosting machine. This study revealed the potential of machine learning algorithms in predicting unfavorable outcomes at discharge among patients with CSDH undergoing burr hole surgery. […] Although statistical analysis has revealed the association of various preoperative factors with the postoperative functional outcome prognosis of CSDH, the predictive ability of classical statistical methods is limited. The factors correlated with poor outcomes among patients with CSDH include age, obesity, preoperative low Glasgow coma scale (GCS) score, bilateral involvement, and radiological factors, such as brain atrophy on head computed tomography (CT). Several studies have used multivariate regression models to predict functional outcomes; however, their discriminative abilities were suboptimal, with area under the curve of the receiver operating characteristic curve (ROC-AUC) ranging from 0.594 to 0.624.
#36 Development of machine learning models for predicting unfavorable functional outcomes from preoperative data in patients with chronic subdural hematomas | Scientific Reports
https://www.nature.com/articles/s41598-023-44029-2
Chronic subdural hematoma (CSDH) often causes neurological deterioration and is treated with hematoma evacuation. This study aimed to assess the feasibility of various machine learning models to preoperatively predict the functional outcome of patients with CSDH. The poor functional outcome was defined as a modified Rankin scale score of 36 upon hospital discharge. The unfavorable outcome was predicted using four machine learning algorithms on an internal held-out cohort (n=188): logistic regression, support vector machine (SVM), random forest, and light gradient boosting machine. This study revealed the potential of machine learning algorithms in predicting unfavorable outcomes at discharge among patients with CSDH undergoing burr hole surgery. […] Although statistical analysis has revealed the association of various preoperative factors with the postoperative functional outcome prognosis of CSDH, the predictive ability of classical statistical methods is limited. The factors correlated with poor outcomes among patients with CSDH include age, obesity, preoperative low Glasgow coma scale (GCS) score, bilateral involvement, and radiological factors, such as brain atrophy on head computed tomography (CT). Several studies have used multivariate regression models to predict functional outcomes; however, their discriminative abilities were suboptimal, with area under the curve of the receiver operating characteristic curve (ROC-AUC) ranging from 0.594 to 0.624.
#37 Development of machine learning models for predicting unfavorable functional outcomes from preoperative data in patients with chronic subdural hematomas | Scientific Reports
https://www.nature.com/articles/s41598-023-44029-2
Chronic subdural hematoma (CSDH) often causes neurological deterioration and is treated with hematoma evacuation. This study aimed to assess the feasibility of various machine learning models to preoperatively predict the functional outcome of patients with CSDH. The poor functional outcome was defined as a modified Rankin scale score of 36 upon hospital discharge. The unfavorable outcome was predicted using four machine learning algorithms on an internal held-out cohort (n=188): logistic regression, support vector machine (SVM), random forest, and light gradient boosting machine. This study revealed the potential of machine learning algorithms in predicting unfavorable outcomes at discharge among patients with CSDH undergoing burr hole surgery. […] Although statistical analysis has revealed the association of various preoperative factors with the postoperative functional outcome prognosis of CSDH, the predictive ability of classical statistical methods is limited. The factors correlated with poor outcomes among patients with CSDH include age, obesity, preoperative low Glasgow coma scale (GCS) score, bilateral involvement, and radiological factors, such as brain atrophy on head computed tomography (CT). Several studies have used multivariate regression models to predict functional outcomes; however, their discriminative abilities were suboptimal, with area under the curve of the receiver operating characteristic curve (ROC-AUC) ranging from 0.594 to 0.624.
#38 Development of machine learning models for predicting unfavorable functional outcomes from preoperative data in patients with chronic subdural hematomas | Scientific Reports
https://www.nature.com/articles/s41598-023-44029-2
The ROC-AUCs of all machine learning approaches in the internal cohort dataset were high (0.9060.925). Adding blood test results into candidate predictors and selecting essential ones from them contributed to the increase in the prediction performance of the machine learning models. The ROC-AUCs of these models showed satisfactory performance, ranging from 0.833 to 0.860 on the external cohort. […] Our study revealed that patients background, clinical findings, and blood test results were useful predictors of postoperative functional prognosis in CSDH patients.
#39 Development of machine learning models for predicting unfavorable functional outcomes from preoperative data in patients with chronic subdural hematomas | Scientific Reports
https://www.nature.com/articles/s41598-023-44029-2
The ROC-AUCs of all machine learning approaches in the internal cohort dataset were high (0.9060.925). Adding blood test results into candidate predictors and selecting essential ones from them contributed to the increase in the prediction performance of the machine learning models. The ROC-AUCs of these models showed satisfactory performance, ranging from 0.833 to 0.860 on the external cohort. […] Our study revealed that patients background, clinical findings, and blood test results were useful predictors of postoperative functional prognosis in CSDH patients.
#40 External validation of prognostic models predicting outcome after chronic subdural hematoma
https://pmc.ncbi.nlm.nih.gov/articles/PMC9519711/
Several prognostic models for outcomes after chronic subdural hematoma (CSDH) treatment have been published in recent years. However, these models are not sufficiently validated for use in daily clinical practice. We aimed to assess the performance of existing prediction models for outcomes in patients diagnosed with CSDH. […] None of the examined models showed good predictive performance for outcomes after CSDH treatment in our dataset. This study confirms the difficulty in predicting outcomes after CSDH and emphasizes the heterogeneity of CSDH patients. The importance of developing high-quality models by using unified predictors and relevant outcome measures and appropriate modeling strategies is warranted. […] The prognostic model of Alford predicted that 15% of patients would die within 30 days, whereas the observed proportion in our data was 4%. Thus, it overestimated the proportion of patients dying within 30 days by 11 percentage points.
#41
https://link.springer.com/article/10.1007/s00701-022-05216-8
Several prognostic models for outcomes after chronic subdural hematoma (CSDH) treatment have been published in recent years. However, these models are not sufficiently validated for use in daily clinical practice. […] None of the examined models showed good predictive performance for outcomes after CSDH treatment in our dataset. This study confirms the difficulty in predicting outcomes after CSDH and emphasizes the heterogeneity of CSDH patients. The importance of developing high-quality models by using unified predictors and relevant outcome measures and appropriate modeling strategies is warranted. […] The prognostic model of Alford predicted that 15% of patients would die within 30 days, whereas the observed proportion in our data was 4%. Thus, it overestimated the proportion of patients dying within 30 days by 11 percentage points.
#42 External validation of prognostic models predicting outcome after chronic subdural hematoma
https://pmc.ncbi.nlm.nih.gov/articles/PMC9519711/
Several prognostic models for outcomes after chronic subdural hematoma (CSDH) treatment have been published in recent years. However, these models are not sufficiently validated for use in daily clinical practice. We aimed to assess the performance of existing prediction models for outcomes in patients diagnosed with CSDH. […] None of the examined models showed good predictive performance for outcomes after CSDH treatment in our dataset. This study confirms the difficulty in predicting outcomes after CSDH and emphasizes the heterogeneity of CSDH patients. The importance of developing high-quality models by using unified predictors and relevant outcome measures and appropriate modeling strategies is warranted. […] The prognostic model of Alford predicted that 15% of patients would die within 30 days, whereas the observed proportion in our data was 4%. Thus, it overestimated the proportion of patients dying within 30 days by 11 percentage points.
#43
https://link.springer.com/article/10.1007/s00701-022-05216-8
Several prognostic models for outcomes after chronic subdural hematoma (CSDH) treatment have been published in recent years. However, these models are not sufficiently validated for use in daily clinical practice. […] None of the examined models showed good predictive performance for outcomes after CSDH treatment in our dataset. This study confirms the difficulty in predicting outcomes after CSDH and emphasizes the heterogeneity of CSDH patients. The importance of developing high-quality models by using unified predictors and relevant outcome measures and appropriate modeling strategies is warranted. […] The prognostic model of Alford predicted that 15% of patients would die within 30 days, whereas the observed proportion in our data was 4%. Thus, it overestimated the proportion of patients dying within 30 days by 11 percentage points.
#44 External validation of prognostic models predicting outcome after chronic subdural hematoma
https://pmc.ncbi.nlm.nih.gov/articles/PMC9519711/
Several prognostic models for outcomes after chronic subdural hematoma (CSDH) treatment have been published in recent years. However, these models are not sufficiently validated for use in daily clinical practice. We aimed to assess the performance of existing prediction models for outcomes in patients diagnosed with CSDH. […] None of the examined models showed good predictive performance for outcomes after CSDH treatment in our dataset. This study confirms the difficulty in predicting outcomes after CSDH and emphasizes the heterogeneity of CSDH patients. The importance of developing high-quality models by using unified predictors and relevant outcome measures and appropriate modeling strategies is warranted. […] The prognostic model of Alford predicted that 15% of patients would die within 30 days, whereas the observed proportion in our data was 4%. Thus, it overestimated the proportion of patients dying within 30 days by 11 percentage points.
#45
https://link.springer.com/article/10.1007/s00701-022-05216-8
Several prognostic models for outcomes after chronic subdural hematoma (CSDH) treatment have been published in recent years. However, these models are not sufficiently validated for use in daily clinical practice. […] None of the examined models showed good predictive performance for outcomes after CSDH treatment in our dataset. This study confirms the difficulty in predicting outcomes after CSDH and emphasizes the heterogeneity of CSDH patients. The importance of developing high-quality models by using unified predictors and relevant outcome measures and appropriate modeling strategies is warranted. […] The prognostic model of Alford predicted that 15% of patients would die within 30 days, whereas the observed proportion in our data was 4%. Thus, it overestimated the proportion of patients dying within 30 days by 11 percentage points.
#46 External validation of prognostic models predicting outcome after chronic subdural hematoma
https://pmc.ncbi.nlm.nih.gov/articles/PMC9519711/
The performance of models in the retrospective database was assessed, and none showed both good discriminative ability and calibration in our data. The most likely explanations of the predictive performance of the models in our data concern suboptimal modeling strategies and differences in study populations. […] The study confirms the complexity of predicting outcomes in patients with CSDH and the need for the collection of standard baseline variables and a core outcome set and for improved modeling strategies, which will improve current prognostic models.
#47
https://link.springer.com/article/10.1007/s00701-022-05216-8
The performance of published models for the prediction of outcomes following CSDH did not perform well in our retrospective database. The study confirms the complexity of predicting outcomes in patients with CSDH and the need for the collection of standard baseline variables and a core outcome set and for improved modeling strategies, which will improve current prognostic models.
#48 Subdural Hematoma: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/1137207-overview
Findings on CT scan or MRI may help indicate prognosis. Such findings may include the following: thickness or volume of the hematoma, degree of midline shift, presence of associated traumatic intraparenchymal lesions, compression of the brainstem or basal cisterns. […] In general, a poor preoperative neurologic status may be a harbinger of a poor outcome. […] Suggested prognostic factors associated with chronic SDH include admission GCS score, radiographic features (eg, midline shift and neomembranes), type of surgical intervention. […] The mortality within 30 days of surgery is 3.2-6.5%. Eighty percent of patients resume their prehematoma level of function. Sixty-one percent of patients aged 60 years or younger and in 76% of patients older than 60 years have favorable outcomes. […] The morbidity and mortality rates associated with surgical treatment of chronic SDH have been estimated at 11% and 5%, respectively. Between 86% and 90% of patients with chronic SDH are adequately treated after one surgical procedure.
#49 Subdural Hematoma: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/1137207-overview
Findings on CT scan or MRI may help indicate prognosis. Such findings may include the following: thickness or volume of the hematoma, degree of midline shift, presence of associated traumatic intraparenchymal lesions, compression of the brainstem or basal cisterns. […] In general, a poor preoperative neurologic status may be a harbinger of a poor outcome. […] Suggested prognostic factors associated with chronic SDH include admission GCS score, radiographic features (eg, midline shift and neomembranes), type of surgical intervention. […] The mortality within 30 days of surgery is 3.2-6.5%. Eighty percent of patients resume their prehematoma level of function. Sixty-one percent of patients aged 60 years or younger and in 76% of patients older than 60 years have favorable outcomes. […] The morbidity and mortality rates associated with surgical treatment of chronic SDH have been estimated at 11% and 5%, respectively. Between 86% and 90% of patients with chronic SDH are adequately treated after one surgical procedure.
#50 Development of machine learning models for predicting unfavorable functional outcomes from preoperative data in patients with chronic subdural hematomas | Scientific Reports
https://www.nature.com/articles/s41598-023-44029-2
This study aimed to predict the functional prognosis in patients with CSDH before undergoing burr hole surgery by employing various machine learning algorithms and utilizing preoperative blood test results and clinical findings as inputs. The practicality and applicability of these predictive models in real-world clinical settings were assessed by performing internal and external validations. […] This study showed that postoperative functional outcome at hospital discharge can be efficiently predicted in patients with CSDH. Although surgical intervention is the primary treatment for most patients with CSDH, some patients require prolonged rehabilitation or transfer to nursing-care facilities and some even experience mortality even after the successful evacuation of hematomas. The frequency of patients with CSDH experiencing these unfavorable outcomes is increasing. Thus, an early indication of postoperative functional status is helpful for health workers in deciding treatment, rehabilitation programs, and the most appropriate discharge destinations for patients with CSDH. Therefore, the accurately prediction of prognosis based on the preoperative information has great clinical value.
#51 Development of the Subdural Hematoma in the Elderly (SHE) score to predict mortality in: Journal of Neurosurgery Volume 132 Issue 5 (2019) Journals
https://thejns.org/view/journals/j-neurosurg/132/5/article-p1616.xml
The SHE score has the best discriminative ability for acute SDH, although it also performed well in cases of chronic and mixed-density SDH. Following requisite external validation and evaluation of reliability, the SHE score may be a valuable tool not only as a framework for medical decision-making but also for clinical research in SDH.
#52
https://journals.lww.com/neurosurgery/fulltext/2017/11000/a_reliable_grading_system_for_prediction_of.14.aspx
The prognostic CSDH grading system is an applicable tool for RrR risk stratification in patients with CSDH. […] The grading system was then applied to the same set of patients in our database to internally validate its predictive power, and the results are presented in Table 4. The estimated rate of postoperative RrR with 95% CI for groups of patients with different total score points on the grading system gave an internal validation measure. Thus, an increase in the prognostic CSDH grading score was associated with a progressive increase in RrR (P .001 for trend; Table 4). […] The prognostic CSDH grading system has been simplified into a reliable clinical grading scale, which may serve several valuable purposes. Thus, standardization of patient assessments using this tool may provide initial individual prognostic information regarding recurrence and reoperation in patients treated with this surgical strategy, which is important to assess surgery benefits and risks and to provide patients and families with such information. […] Combining subcomponents in the prognostic grading system is a powerful and applicable tool for postoperative RrR risk stratification in patients with CSDH.