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Factors influencing wait-and-watch management in mild primary chronic subdural hematoma: a retrospective case-control
Xinjie Zhang1,2, Zhuang Sha1,2, Chuang Gao1,2
1Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
Insights
For mild chronic subdural hematoma, larger hematoma volume and hypodense appearance predict poor outcomes with conservative wait-and-watch management. These factors help identify patients needing medical intervention.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Chronic subdural hematoma (CSDH) is a common neurosurgical condition.
- Wait-and-watch management is a conservative approach for mild CSDH.
- Identifying prognostic factors is crucial for optimizing treatment decisions.
Purpose of the Study:
- To identify prognostic factors for patients with primary CSDH undergoing wait-and-watch management.
- To determine independent predictors of treatment response in mild CSDH.
Main Methods:
- A case-control study included 39 responders and 24 non-responders to wait-and-watch management.
- Patients were matched for key demographic and clinical variables.
- Baseline data included demographics, blood counts, serum chemistry, and imaging features.
Main Results:
- Univariate analysis showed significant differences in hematoma volume, maximal thickness, hypodensity, and urinary function.
- Multivariate analysis identified hypodense hematoma and hematoma volume as independent predictors.
- A predictive model combining these factors achieved an AUC of 0.741.
Conclusions:
- Hematoma volume and hypodensity are key prognostic factors in mild CSDH treated conservatively.
- These findings can assist clinicians in selecting appropriate management strategies.
- Consideration of medical interventions is advised for patients with unfavorable prognostic factors.
Purpose:
To identify prognostic factors in patients with primary chronic subdural hematoma (CSDH) undergoing wait-and-watch management.
Methods:
A case-control study was conducted in a single center from February 2019 to November 2021 to identify independent influencing factors of wait-and-watch management in mild CSDH patients using wait-and-watch as monotherapy. A total of 39 patients who responded to wait-and-watch management (cases) and 24 nonresponders (controls) matched for age, sex, height, weight, MGS-GCS (Markwalder grading scale and Glasgow Coma Scale), and bilateral hematoma were included. Demographics, blood cell counts, serum biochemical levels, imaging data, and relevant clinical features at baseline were collected.
Results:
Univariate analysis revealed significant differences between cases and controls in hematoma volume, ability to urinate, maximal thickness of the hematoma, and hypodensity of the hematoma. Hypodense hematoma and hematoma volume were independently associated with the outcome in multivariate analysis. Combining these independently influencing factors revealed an area under the receiver operator characteristic curve of 0.741 (95% CI 0.609-0.874, sensitivity = 0.783, specificity = 0.667).
Conclusions:
The results of this study may aid in identifying patients with mild primary CSDH who could benefit from conservative management. While wait-and-watch management may be an option in some cases, clinicians need to suggest medical interventions, such as pharmacotherapy, when appropriate.
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