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Predictors of Functional Outcome After Subdural Hematoma: A Prospective Study
Jonathan M Weimer1, Errol Gordon2, Jennifer A Frontera3
1Cerebrovascular Center of the Neurological Institute, Cleveland Clinic, 9500 Euclid Ave. S80, Cleveland, OH, 44195, USA.
Neurocritical Care
|May 28, 2016
Summary
Subdural hematoma (SDH) patients face poor outcomes, with nearly 50% disabled or deceased at 3 months. Predictors of poor outcomes include older age, smoking, and fever, while surgery may improve results for some SDH types.
Area of Science:
- Neurosurgery
- Neurology
- Clinical Medicine
Background:
- Subdural hematoma (SDH) incidence is rising in the US.
- Limited prospective data exist on SDH risk factors for poor outcomes.
Purpose of the Study:
- To identify independent predictors of poor outcome in subdural hematoma patients.
- To compare outcomes between surgical and non-surgical management of SDH.
Main Methods:
- Prospective observational study of 116 consecutive SDH patients (7/2008-11/2011).
- Collected baseline clinical data, hospital course, complications, and imaging.
- Used multivariable logistic regression to identify predictors of poor 3-month outcomes (modified Rankin Scores [mRS] 4-6).
Main Results:
- 53% of patients had good outcomes (mRS 0-3) at 3 months; 47% had poor outcomes (mRS 4-6).
- Surgical evacuation improved outcomes (57% good vs. 32% without surgery).
- Older age, poor admission Glasgow Coma Score, smoking, and fever predicted poor outcomes.
Conclusions:
- Nearly 50% of SDH patients experience severe disability or death at 3 months.
- Older age, poor neurological status, smoking, and fever are key predictors of poor outcomes.
- Surgical evacuation shows promise for improving outcomes in mixed acuity or chronic/subacute SDH.
