Acute subdural hematomas in nonagenarians and centenarians

Area of Science:

• Neurosurgery
• Geriatric Medicine
• Trauma Surgery

Background:

• Limited research exists on acute traumatic subdural hematoma (SDH) outcomes in patients aged 90 years and older.
• This demographic presents unique challenges and considerations for acute care.

Purpose of the Study:

• To characterize the presentation and acute outcomes of patients aged 90+ with acute SDH.
• To identify factors associated with favorable outcomes in this elderly population, particularly surgical candidates.

Main Methods:

• Analysis of 117 patients aged 90+ with acute SDH (2013-2023).
• Multivariable logistic regression to assess predictors of favorable outcome (discharge to non-hospice facility with GCS ≥ 14).
• Wilcoxon rank-sum and Chi-squared tests for nominal and categorical data analysis.

Main Results:

• Overall mortality was 7.7%, with 86.3% achieving a favorable outcome.
• Surgery was performed in 8 patients, with 62.5% experiencing a favorable outcome.
• Prior independence and higher admission Glasgow Coma Scale (GCS) scores were significantly associated with favorable outcomes.

Conclusions:

• A majority of patients aged 90+ with acute SDH experience favorable outcomes.
• Pre-existing independence and higher GCS scores are key indicators for positive discharge status.
• Craniotomy for acute SDH can yield good results in select elderly patients, warranting consideration for surgical intervention.