gms | German Medical Science

70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

Treatment algorithm for geriatric patients with acute subdural haematoma in neurological good condition – Is it always surgery?

Behandlungsalgorithmus für geriatrische Patienten mit akut subduralem Hämatom in gutem neurologischen Zustand – Ist es immer die Chirurgie?

Meeting Abstract

  • presenting/speaker Andreas Kneist - Uniklinik Essen, Neurochirurgie, Essen, Deutschland
  • Marvin Darkwah Oppong - Uniklinik Essen, Neurochirurgie, Essen, Deutschland
  • Philipp Dammann - Uniklinik Essen, Neurochirurgie, Essen, Deutschland
  • Ulrich Sure - Uniklinik Essen, Neurochirurgie, Essen, Deutschland
  • Oliver Müller - Uniklinik Essen, Neurochirurgie, Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV187

doi: 10.3205/19dgnc179, urn:nbn:de:0183-19dgnc1793

Published: May 8, 2019

© 2019 Kneist 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: Acute subdural hematoma (aSDH) is a life-threatening condition urging immediate surgery. Demographic changes bring along a raising number of elderly patients presenting in good neurological condition with aSDH. This retrospective analysis focuses on non-operative management or delayed surgery in octogenerians with respect to their clinical outcome.

Methods: The medical records of all patients with aSDH treated between 2008 and 2016 were retrospectively analysed. Data of 100 patients aged 70 years or older with an initial Glasgow Coma Score (GCS) of 13–15 were assessed. Initial computed tomography (CT) scan and treatment pathway were obtained from the records as well as Glasgow Outcome Score (GOS) on discharge and latest follow up.

Results: Sixty-seven patients were conservatively treated initially, of whom 31 patients (46%) underwent surgery after a mean 4.7 days (range 0.25–30d). Outcome was good, defined as a GOS of 4 or better at latest follow up, in 48% of the patients receiving urgent evacuation compared to overall 78% of the patients conservatively treated at admission (p=0.003). Focusing on the GOS only in the group of patients treated surgically, there was no difference between urgent or delayed surgery. All patients, who were only operated when their aSDH had transformed into a chronic subdural hematoma (cSDH), had a good outcome without exception. Preexisting anticoagulation had neither significant impact on outcome, midline-shift at presentation, timing of surgery nor post-/ intraoperative bleeding complications.

Conclusion: In elderly patients presenting in good neurological condition it may be justified to postpone surgery in selected cases as – according to our data – delayed surgery is not associated with an unfavourable outcome. Some of these patients, being discharged without operation, may even benefit with a favourable outcome compared to the operated ones. Yet, our data have to be interpreted with caution, bearing in mind that an aSDH is always a life threating condition. Thus, not operating on a patient immediately, may not reduce the chance of survival. Rather a continuous surveillance on an intensive care unit with continuous neurosurgical stand-by should be warranted to detect any deterioration of the patients’ condition.