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Pre-Chiasmatic, Single Injection of Autologous Blood to Induce Experimental Subarachnoid Hemorrhage in a Rat Model
Published on: June 18, 2021
Chronic subdural hematoma in the elderly: not a benign disease
Lucas Bernardes Miranda1, Ernest Braxton, Joseph Hobbs
1Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
Journal of Neurosurgery
|September 28, 2010
Summary
Chronic subdural hematoma (CSDH) in the elderly is not benign, with significant excess mortality observed up to one year post-diagnosis. This condition indicates underlying chronic diseases, similar to hip fracture, and requires careful long-term monitoring.
Area of Science:
- Neurosurgery
- Geriatric Medicine
- Public Health
Background:
- Chronic subdural hematoma (CSDH) is often considered a benign condition in elderly patients.
- Follow-up periods for CSDH are typically short, limited to acute hospitalization, potentially masking long-term outcomes.
Purpose of the Study:
- To investigate the long-term survival and mortality rates of elderly patients diagnosed with chronic subdural hematoma (CSDH).
- To challenge the perception of CSDH as a benign condition in the elderly population.
Main Methods:
- Retrospective review of a prospectively identified consecutive series of adult patients with CT-diagnosed CSDH (September 2000 - February 2008).
- Analysis included various surgical interventions (bur holes, twist-drill drainage, craniotomies) and observation.
- Survival data were compared to life-table data, with multivariate and Cox proportional hazards models used for analysis.
Main Results:
- The study analyzed 209 elderly patients (mean age 80.6 years).
- In-hospital mortality was 16.7%, with 6-month and 1-year mortality rates of 26.3% and 32%, respectively.
- Long-term survival analysis revealed a markedly increased mortality rate in the CSDH group compared to actuarial survival (median survival 4.4 vs. 6 years), with excess mortality persisting up to 1 year post-diagnosis. Neurological status on admission and age were predictors of mortality, while intervention type did not significantly affect outcomes.
Conclusions:
- CSDH in the elderly is associated with persistent excess mortality for up to one year, refuting its 'benign' status.
- The findings suggest CSDH serves as a marker for underlying chronic diseases in the elderly, akin to hip fracture.
- Long-term follow-up and management strategies should consider CSDH as an indicator of significant comorbidities.
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