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Published on: October 15, 2021
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Neurologic Outcomes for Octogenarians Undergoing Emergent Surgery for Traumatic Acute Subdural Hematoma
Evan M Krueger1, Ronald J Benveniste1, Ruby R Taylor2
1Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
World Neurosurgery
|December 15, 2022
Summary
Determining surgical indications for elderly patients with traumatic acute subdural hematoma (aSDH) is difficult. Optic nerve sheath diameter (ONSD) may help predict outcomes, but more research is needed.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Geriatric Medicine
Background:
- Surgical decision-making for obtunded octogenarians with traumatic acute subdural hematoma (aSDH) presents challenges.
- Identifying easily accessible data for early surgical indication assessment is crucial.
Purpose of the Study:
- To evaluate clinical and radiographic data for predicting surgical outcomes in elderly patients with aSDH.
- To assess the utility of optic nerve sheath diameter (ONSD) as a predictive tool.
Main Methods:
- Retrospective review of 17 patients aged ≥80 years with traumatic aSDH undergoing emergent surgery.
- Clinical data (Karnofsky, Charlson, GCS) and radiographic data (Rotterdam CT score, aSDH thickness, midline shift, ONSD) were collected.
- Neurologic outcomes assessed using extended Glasgow Outcome Scale-Extended (GOS-E) at discharge and 3 months.
Main Results:
- Significant negative correlations were observed between ONSD and Glasgow Coma Scale (GCS) score (r = -0.62; P < 0.01).
- ONSD also showed a negative correlation with discharge GOS-E score (r = -0.49; P = 0.05).
- Abbreviated Injury Score was significantly associated with discharge GOS-E score (P = 0.05).
Conclusions:
- Octogenarians with aSDH requiring emergent surgery generally experience poor outcomes.
- Further investigation is required to establish ONSD as a reliable adjunct for predicting surgical efficacy in this population.
