Article
The modified subdural haematoma in the elderly score – improving a novel tool to predict mortality in elderly patients suffering from chronic subdural haematoma
Das modifizierte subdurale Hämatom im Elderly Score – Ergänzung eines neuen Modells zur Vorhersage von Mortalität bei geriatrischen Patienten mit chronischem Subduralhämatom
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Authors
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Alisa von Seydlitz-Kurzbach
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
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Christina Wolfert
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
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Veit Rohde
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
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Christian von der Brelie
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
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Silvia Hernández-Durán
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: The Subdural Hematoma in the Elderly (SHE) score was published in April 2019 as a novel tool to predict mortality and outcome in elderly patients suffering from subdural hematomas resulting from minor or no trauma. However, the authors included both acute and chronic (CSDH) hematomas in their analysis, thus negating the underlying differences in the pathomechanisms mediating brain injury and clinical presentation between these entities. In this study, we attempted to validate the SHE in a cohort of only CSDH.
Methods: We applied the SHE in a retrospective cohort of elderly (>65 years) patients with CSDH admitted at our center from January 2015 to September 2019. Receiver operative characteristic (ROC) curves were then calculated for both 30-day mortality and outcome. Outcome was dichotomized as "good" for Glasgow Outcome Score (GOS) 4-5, and "poor" for GOS 1-3. Further variables were analyzed in our cohort as potential predictors of mortality, such as anticoagulant use, and hematoma appearance on imaging. Neurological status was further categorized with Markwalder grade. Statistically significant variables were then incorporated into a modified SHE (mSHE), which was then evaluated with ROC for 30-day mortality and outcome and compared to the SHE.
Results: A total of 171 patients were included. Mean age was 79 years (range: 65-95). Most patients were males (n=113, 66%), and used anticoagulants (n=104, 61%). Glasgow Coma Scale (GCS) was between 13-15 points in most patients (n=138, 81%), but patients had moderate to severe neurological deficits not captured by GCS (Markwalder ≥2, n=111, 65%). An even distribution between trabecular and laminar hematomas was seen (n=99, 58%, and n=72, 42%, respectively), and mean hematoma volume was 61cc (range: 27-317). Mortality was low at n=7/171, 4%. SHE failed to predict mortality in our cohort (AUC=.56) but performed well for outcome prediction (AUC=.74). By adding the Markwalder grade into the SHE (mSHE), we were able to increase performance in mortality prediction (AUC=.67). Outcome prediction was similar for the mSHE (AUC=.75).
Conclusion: The SHE seems a reliable tool to predict outcome after CSDH in the elderly. However, incorporating a more detailed quantification of neurological deficits might increase its performance in mortality prediction.
