A Validation Study for SHE Score for Acute Subdural Hematoma in the Elderly

Area of Science:

• Neurology
• Neurosurgery
• Geriatrics

Background:

• Acute subdural hematoma (aSDH) in elderly patients presents a significant mortality challenge.
• The Subdural Hematoma in the Elderly (SHE) score was proposed to predict mortality in this population.
• Validation of existing predictive scores is crucial for clinical decision-making.

Purpose of the Study:

• To verify the Subdural Hematoma in the Elderly (SHE) score's efficacy as a mortality predictor in patients over 65 with non-traumatic/minor trauma aSDH.
• To identify additional independent predictors of poor outcomes in this patient cohort.

Main Methods:

• A cohort of 131 elderly patients with aSDH treated between 2008 and 2020 was analyzed.
• Patients were scored using age, Glasgow Coma Scale (GCS) on admission, and subdural hematoma (SDH) volume.
• Multivariate logistic regression identified independent risk factors for 30-day mortality.

Main Results:

• The study replicated Alford et al.'s findings, showing consistent 30-day mortality rates across SHE score categories (0-4).
• Status epilepticus (SE) occurred in 18 patients, all resulting in 100% mortality, irrespective of SHE score.
• Surgical evacuation was identified as the sole significant risk factor for developing SE (p = 0.0065).

Conclusions:

• The SHE score is a reliable mortality predictor for elderly patients with aSDH from minor trauma.
• Status epilepticus is a significant factor limiting life expectancy, particularly in patients undergoing surgical evacuation for aSDH.