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Predicting Prognosis of Patients with Chronic Subdural Hematoma: A New Scoring System
Churl-Su Kwon1, Omar Al-Awar2, Oliver Richards1
1Department of Neurosurgery, Leeds General Infirmary, Leeds, United Kingdom.
Insights
A new scoring system helps predict outcomes for chronic subdural hematoma (CSDH) patients. This tool aids surgeons in determining the necessity of operative intervention for CSDH.
Area of Science:
- Neurosurgery
- Geriatric Medicine
- Medical Imaging
Background:
- Chronic subdural hematoma (CSDH) is a common neurosurgical condition, particularly in the aging population.
- Elderly and comorbid patients with symptomatic CSDH present unique management challenges.
- Accurate prognostication is crucial for surgical decision-making in CSDH.
Purpose of the Study:
- To evaluate clinical and radiologic factors associated with CSDH outcomes.
- To develop a novel scoring system for predicting patient prognosis after CSDH evacuation.
- To assist in determining the necessity of surgical intervention for CSDH.
Main Methods:
- A retrospective cohort study of CSDH patients from 2010-2015.
- Logistic regression analysis to identify predictors of a favorable (modified Rankin Scale 0-1) or unfavorable (mRS 2-6) outcome at 1-year follow-up.
- Development of a prediction rule and scoring system based on significant prognostic factors.
Main Results:
- Age >75 years, midline shift >10 mm, and hematoma thickness >30 mm were significantly associated with unfavorable outcomes.
- A scoring system ranging from 3 (worst prognosis) to 13 (best prognosis) was developed.
- A score of ≥9 indicated a favorable outcome, with excellent model discrimination (AUC = 0.95).
Conclusions:
- A validated scoring system can effectively predict outcomes in CSDH patients.
- This tool can aid clinicians in assessing the need for surgery in diverse patient groups.
- The scoring system offers valuable prognostic information for CSDH management.
Objective:
Chronic subdural hematoma (CSDH) is a commonly encountered neurosurgical pathology that frequently requires operative intervention. With an increasing ageing demographic, more elderly and comorbid patients will present with symptomatic CSDH. This study evaluated clinical and radiologic factors to create a scoring system to aid prognostication.
Methods:
A cohort of patients undergoing evacuation of CSDH at a single institution was established from 2010 to 2015. Primary endpoint was a dichotomized score on a modified Rankin Scale score at 1-year follow-up (favorable outcome score 0-1; unfavorable outcome score 2-6). Logistic regression analyses were performed to model determinants related to outcome. A prediction rule for diagnosing poor postoperative prognosis with unfavorable modified Rankin Scale score was developed with the obtained results.
Results:
Logistic regression analyses showed that age >75 years, midline shift >10 mm, and hematoma thickness >30 mm were significantly associated with unfavorable outcome (age >75 years: odds ratio [OR] 0.01, 95% confidence interval [CI] 0.001-0.01; midline shift 11-20 mm: OR 0.18, 95% CI 0.04-0.88; midline shift >20 mm: OR 0.03, 95% CI 0.002-0.41; hematoma thickness >30 mm: OR 0.07, 95% CI 0.01-0.46). A scoring system was designed using the final fitted multivariate model. A minimum score of 3 is feasible, indicating worst prognosis, and maximum score of 13 is feasible, indicating best prognosis. A score of ≥9 showed favorable outcome. Receiver operating characteristic curves were constructed to predict favorable versus unfavorable outcomes with the sensitivity analysis yielding an excellent model discrimination with an area under curve of 0.95, 95% CI 0.92-0.98.
Conclusions:
A scoring system has been devised to predict outcome, which can aid in the necessity of surgery in certain patient demographics.
