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Decision making in chronic subdural haematoma patient referrals in an octogenarian and nonagenarian population - a

Joshua MacArthur1, Sayan Biswas2, Lareyna McMenemy1

  • 1Faculty of Biology, Medicine and Health, University of Manchester, Manchester, Greater Manchester, UK.

Irish Journal of Medical Science
|May 14, 2026
PubMed

Insights

Chronic subdural haematoma (CSDH) referral acceptance is lower in the very elderly. CSDH size and premorbid quality of life (QoL) are key predictors for neurosurgical intervention in all age groups.

Area of Science:

  • Neurosurgery
  • Geriatric Medicine
  • Public Health

Background:

  • Chronic subdural haematoma (CSDH) incidence is increasing among the elderly population.
  • Limited research exists on CSDH management in patients over 80.
  • Referral acceptance by tertiary centers dictates neurosurgical intervention in the UK.

Purpose of the Study:

  • To identify predictors of neurosurgical referral acceptance for chronic subdural haematoma (CSDH) in octogenarian and nonagenarian patients.
  • To compare referral acceptance predictors between ultra-elderly (≥80 years) and adult (<80 years) populations.
  • To analyze the influence of age, clinical presentation, CSDH characteristics, and premorbid quality of life (QoL) on referral acceptance.

Main Methods:

  • A multi-center retrospective case series analysis (January 2015 - May 2020).
  • Patients categorized as adult (<80 years) or ultra-geriatric (≥80 years), with further subgrouping into octogenarians (80-89) and nonagenarians (≥90).
  • Multivariable logistic regression utilized to assess predictors including age, headache, dementia, motor weakness, midline shift, CSDH size, and premorbid QoL.

Main Results:

  • Referral acceptance was significantly lower in ultra-geriatric patients (22.4%) compared to adults (38.1%) and in nonagenarians (10.5%) versus octogenarians (27.7%).
  • CSDH size and premorbid QoL were consistent independent predictors of acceptance across all age groups.
  • Predictor significance varied by age group; in nonagenarians, only age, CSDH size, and QoL were significant.

Conclusions:

  • CSDH size and premorbid QoL are crucial independent predictors for neurosurgical referral acceptance in all age groups.
  • These factors are particularly important for the octogenarian and nonagenarian populations.
  • Other clinical variables demonstrate age-dependent significance in predicting referral acceptance for CSDH management.
Abstract

Keywords:
Chronic Subdural HaematomaNational Health ServiceNonagenarianOctogenarian

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