Friday, June 22, 2012

Chronic Subdural Hematoma: A Sentinel Health Event

Publication year: 2012
Source:World Neurosurgery
Travis M. Dumont, Anand I. Rughani, Tara Goeckes, Bruce I. Tranmer
Objective Elderly patients are prone towards developing chronic subdural hematomas due to incidence of co-morbidities requiring anti-platelet or anticoagulant medications and a predilection for falls. The authors propose that chronic subdural hematoma (CSDH) should be conceived as a sentinel event in the elderly and offer an analysis of the long-term survival following diagnosis. Methods A retrospective review of 301 consecutive patients aged 55 years or older admitted to an academic medical center with primary diagnosis of CSDH between January 1996 and January 2010 was performed. The effects of advanced age and surgical intervention on survival were independently assessed. These groups were compared to standardized mortality ratios on the basis of patient age at time of presentation. Results Mortality incidence after diagnosis of CSDH increases with increased age at presentation. For all patients, the median survival was roughly four years after diagnosis (4.0 ± 0.5 years). Median survival is decreased with older age at presentation, to a nadir of 1.5 ± 0.6 years for patients aged over 85 years (p = 0.0003, log-rank test). Compared to the reference data from the Centers of Disease Control, the one year standardized mortality ratio was increased in all age groups. An asymmetric increase in standardized mortality ratio was seen between age groups, with the greatest effect on the youngest subpopulation (standardized mortality ratio 2.9). Conclusions The increased mortality rates in patients with chronic subdural hematomas relative to standardized mortality data corroborate the conception of subdural hematoma as sentinel health event.






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