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Causes and Trauma Apportionment Score of Chronic Subdural Hematoma
Kyeong-Seok Lee1, Seok-Mann Yoon1, Jae-Sang Oh1
1Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
Insights
The trauma apportionment score (TAS) helps determine the causes of chronic subdural hematoma (CSH). This score indicated that trauma was more common than spontaneous CSH, especially in older adults.
Area of Science:
- Neurology
- Neurosurgery
- Trauma Medicine
Background:
- The pathophysiology of chronic subdural hematoma (CSH) remains unclear, with varying injury thresholds in different age groups.
- Causality and trauma apportionment are critical for understanding CSH, particularly in clinical and insurance contexts.
Purpose of the Study:
- To evaluate the utility of the trauma apportionment score (TAS) in differentiating the causes of chronic subdural hematoma (CSH).
- To analyze the contributing factors (subdural reservoir, trauma, coagulopathy) in CSH development using the TAS.
Main Methods:
- Retrospective analysis of 239 consecutive CSH cases.
- Application of the trauma apportionment score (TAS) based on patient history and laboratory results.
- Statistical analysis including Fisher's exact test to compare patient groups.
Main Results:
- The TAS ranged from -5 to 5, with a median score of 0.
- CSH causes were classified as combined in 12.6% (TAS=0) to 44.8% (TAS=-1 to 1) of cases.
- Traumatic CSH was more frequent than spontaneous CSH, and spontaneous CSH was more prevalent in older patients (p<0.01).
Conclusions:
- The trauma apportionment score (TAS) is an effective tool for distinguishing the causality of chronic subdural hematoma (CSH).
- The study highlights the differential contribution of trauma and spontaneous factors in CSH development across age groups.
Objective:
The pathophysiology of chronic subdural hematoma (CSH) is not yet clear. Trauma alone is not sufficient to result in CSH in young individuals, while a trivial injury can result in CSH in older adults. Although the causality and apportionment of trauma are important issues in CSH, especially in terms of insurance, it is too obscure to solve all struggles.
Methods:
There are three key factors for producing CSH. First, CSH necessitates a potential subdural reservoir. Other important precipitating factors are trauma and coagulopathy. However, these factors are not sufficient to cause CSH development. The trauma apportionment score (TAS) can be used to compare the relative importance of these three factors. Here, we applied the TAS to 239 consecutive cases of CSH. We retrospectively obtained the patients' history and laboratory results from their medical records.
Results:
The TAS ranged from -5 to 5. The most common score was 0. If we defined the cause of CSH as being combined when the TAS was 0, then the cause was combined in 30 cases (12.6%). If we extended the criteria for a combined cause from 0 to -1 to 1, the cause was combined in 107 cases (44.8%). Regardless of the criteria used, traumatic CSHs were more common than were spontaneous CSHs. Spontaneous CSHs were more common in older than in younger patients (p<0.01, Fisher's exact test).
Conclusion:
The TAS is a useful tool for differentiating the causality of CSH.
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