gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Chronic Subdural Hematoma: The Impact of Head Trauma and Anticoagulative Medication, a Single Center Experience

Meeting Abstract

  • Felix Kramer - Klinik für Neurochirurgie, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
  • Julia Patzer - Klinik für Neurochirurgie, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
  • Henning Hosch - Klinik für Neurochirurgie, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
  • Jörn Leibling - Klinik für Neurochirurgie, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
  • Dag Moskopp - Klinik für Neurochirurgie, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 094

doi: 10.3205/17dgnc657, urn:nbn:de:0183-17dgnc6570

Published: June 9, 2017

© 2017 Kramer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Chronic subdural hematoma (cSDH) is a common form of intracranial haemorrhage, especially in elderly patients. It plays an increasingly important role in context of the demographic change with increasingly aged patients with many comorbidities & associated treatment costs. Head trauma & oral anticoagulative medication (OAC) are discussed as influential factors for treatment duration, recurrent SDH & discharge modality. Aim of this study was to show the effect of both: head trauma & OAC on course of cSDH treatment.

Methods: A retrospective analysis was performed, 2 groups were formed: group1 with memorable/observed head trauma; group2 w/o head trauma. Both groups were analysed according to basic characteristics, treatment with OAC, duration of hospital treatment, modality of discharge & need for recurrent surgery. OAC was defined as history of OAC medication + altered blood samples (high INR, prolonged PFA); INR was lowered (e.g. PPSB) prior to operation. Primary endpoint was duration in hospital & discharge modality (rehab, hospital, home). Statistical performance included χ2-, t- & Mann-Whitney-test, level of statistical sign. was assumed at p<0.05.

Results: Between 01/2010 & 12/2015 n=207 pat. with cSDH were enrolled. Group1 contained n=56; group2 n=151. Most pat. were male (71%) & 60 - 80 yrs old (6% <60yrs, 33% >80yrs). No difference in gender distribution nor age (mean age ~75yrs) in both groups was found. Although in group 1 most pat. (60.7%) took OAC & group 2 was dominated by pat. w/o OAC (53.6%), no significant difference was found (p=0.08). All tests didn’t show any significant disadvantage for pat. with OAC in comparison to no OAC. Hospital stay was significantly shorter in pat. w/o head trauma (group1 12.0d, group2 14.7d, p=0.02). In both groups OAC had neither significant impact on hospital stay nor requirement of recurrent operation. >60% pat. in group1 were discharged home, while 50% pat. in group 2 needed direct admittance to rehab/another hospital (p=0.16). OAC had no impact on discharge modality in both groups.

Conclusion: In most forms of intracranial bleeding OAC has significant impact on hospital stay and/or need for rehabilitation. cSDH patients with head trauma had longer hospital admittance & were less likely to be discharged home. OAC had no significant influence on duration of hospital stay & discharge modality in both groups. In literature there are different studies with similar results. Yet there are few studies looking deeper on effects & mechanisms which lead to inferior outcome of cSDH after head trauma. According to our results, history of head trauma should be paid as much attention as commonly is paid to reviewing anticoagulation. The results stretch the importance of detecting head trauma as a predictive item & underline the need for falling prevention in all elderly patients. Furthermore they suggest more research on mechanisms of cSDH in head trauma.