Article
Subdural Hematoma in the Elderly (SHE) score – reliable predictor for outcome of minor trauma acute subdural haematoma with status epilepticus as additional independent mortality factor
Subdural Hematoma in the Elderly (SHE) score – ein zuverlässiger Prediktor für das Outcome bei akut subduralen Hämatomen im Rahmen leichter Traumata mit einem Status epileptikus als zusätzlicher unabhängiger Mortalität-Faktor
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Published: | June 4, 2021 |
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Objective: The aim of this study was the verification of the Subdural Hematoma in the Elderly (SHE) score proposed by Alford et al. as mortality predictor in patients older than 65 years with non-traumatic/minor trauma acute subdural hematoma (aSDH). Additionally, we evaluated further predictors associated with poor outcome.
Methods: The patients were scored according to age (1 point is given if patients were older than 80 years), GCS by admission (1 point for GCS 5-12, 2 points for GCS 3-4) and SDH volume (1 point for volume > 50 ml). The sum of points determines the SHE score. The multivariate logistic regression analysis was performed to identify additional independent risk factor associated with 30-day mortality.
Results: 131 patients with aSDH were treated at our institution. We observed the same 30-day mortality rates published by Alford et al.: SHE 0: 4.3% vs. 3.2%, p = 1.0; SHE 1: 12.2% vs. 13.1%, p = 1.0; SHE 2: 36.6% vs. 32.7%, p = 0.8; SHE 3: 97.1% vs. 95.7%, p = 1.0 and SHE 4: 100% vs. 100%, p = 1.0. Additionally, 18 patients who developed status epilepticus (SE) had a mortality of 100% regardless of the SHE score. The distribution of SE among the groups was: 1 for SHE 1, 6 for SHE 2, 9 for SHE 3 and 2 for SHE 4. The only statistically significant risk factor for developing SE was surgery (RR=1.395; CI= 1.242-1.566; p=0.006). Furthermore, SHE 3 and 4 showed no difference regarding the outcome between surgical and conservative treatment.
Conclusion: SHE score is a reliable mortality predictor for non-traumatic/minor trauma acute subdural hematoma in elderly patients. Besides, we identified status epilepticus as a strong life-expectancy limiting factor in patients undergoing surgical evacuation.