gms | German Medical Science

Background: Acute subdural hematoma (aSDH) is a common disease and is increasing in prevalence due to the aging demographic alteration. Yet, the functional outcomes, predictors for outcome and neurosurgical intervention in elderly patients, particularly over 80 years of age, remain unclear. Indeed, this cohort was under investigated in the past.

Method: The author analysed 68 consecutive patients with aSDH surgically treated in the neurosurgical department within the past nine years. Following parameters were assessed: baseline characteristics, admission clinical status, art of surgical procedures, clinical status 24 hours after operation, seizure, radiographic characteristics and comorbidities. Functional outcome was assessed by Glasgow Outcome Scale (GOS) at hospital discharge and three months follow-up (FU). GOS 1-3 were considered as unfavourable outcome.

Result: The mean age was 85 years (range 80-96) and 44% were female. Overall mortality rate was 28% at discharge and 48% at FU. Independent predictors for unfavourable outcome at discharge were GCS≤8 24 hours after operation (p=0.001) and pneumonia (p=0.02). At FU, GCS≤8 24 hours after operation (p<0.001) and cumulative comorbidities (≥5) (p=0.05) were significant parameters for unfavourable outcome. All patients with more than 6 comorbidities died at FU. Surgical treatment in comatose patient had significant higher mortality rate at discharge and FU compared to patients with non-comatose status (p=0.04). After FU, 23% of comatose patient and more than 50% of non-comatose patient had favourable outcome (p=0.06). The incidence of seizures was 44%. Predictors for seizures were GCS≤8 24 hours after operation (p=0.02) and left side hematoma (p=0.02). The occurrence of seizure was associated with unfavourable outcome as well.

Conclusion: Overall the outcome in elderly patient with aSDH improved in the course, depending on the severity of aSDH and the accumulation of comorbidities. Surgical intervention might be beneficial in non-comatose patients and patients with less than 5 comorbidities with obtaining favourable outcome in more than 50%, however particularly surgery in comatose patients with more than 6 comorbidities should be seriously discussed. In particular the occurrence of seizure is high and as an important determinant of outcome, the use of prophylactic antiepileptic treatment should be considered with wide range indication.