J Korean Neurosurg Soc.  2017 Feb;60(2):239-249. 10.3340/jkns.2016.0404.009.

Radiologic Findings and Patient Factors Associated with 30-Day Mortality after Surgical Evacuation of Subdural Hematoma in Patients Less Than 65 Years Old

• Han MH
• Ryu JI
• Kim CH
• Kim JM
• Cheong JH
• Yi HJ

• KMID: 2374887
• DOI: http://doi.org/10.3340/jkns.2016.0404.009

Abstract

OBJECTIVE
The purpose of this study is to evaluate the associations between 30-day mortality and various radiological and clinical factors in patients with traumatic acute subdural hematoma (SDH). During the 11-year study period, young patients who underwent surgery for SDH were followed for 30 days. Patients who died due to other medical comorbidities or other organ problems were not included in the study population.
METHODS
From January 1, 2004 to December 31, 2014, 318 consecutive surgically-treated traumatic acute SDH patients were registered for the study. The Kaplan-Meier method was used to analyze 30-day survival rates. We also estimated the hazard ratios of various variables in order to identify the independent predictors of 30-day mortality.
RESULTS
We observed a negative correlation between 30-day mortality and Glasgow coma scale score (per 1-point score increase) (hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.52-0.70; p<0.001). In addition, use of antithrombotics (HR, 2.34; 95% CI, 1.27-4.33; p=0.008), history of diabetes mellitus (HR, 2.28; 95% CI, 1.20-4.32; p=0.015), and accompanying traumatic subarachnoid hemorrhage (hazard ratio, 2.13; 95% CI, 1.27-3.58; p=0.005) were positively associated with 30-day mortality.
CONCLUSION
We found significant associations between short-term mortality after surgery for traumatic acute SDH and lower Glasgow Coma Scale scores, use of antithrombotics, history of diabetes mellitus, and accompanying traumatic subarachnoid hemorrhage at admission. We expect these findings to be helpful for selecting patients for surgical treatment of traumatic acute SDH, and for making accurate prognoses.

Keyword

Subdural hematoma; Traumatic brain injury; Mortality; Traumatic subarachnoid hemorrhage

MeSH Terms

Brain Injuries
Comorbidity
Diabetes Mellitus
Glasgow Coma Scale
Hematoma, Subdural*
Hematoma, Subdural, Acute
Humans
Methods
Mortality*
Prognosis
Subarachnoid Hemorrhage, Traumatic
Survival Rate

Figure

• 

  Fig. 1 Flow chart of the process for selecting eligible patients from our hospital’s Traumatic Brain Injury registry during the period from January 1, 2004 to December 31, 2014.

• 

  Fig. 2 Dichotomized analysis of the distribution of initial accompanying brain injuries in patients who survived or died within 30 days of surgery for acute subdural hematoma. TICH: traumatic intracerebral hematoma, tSAH: traumatic subarachnoid hemorrhage, IVH: intraventricular blood, EDH: epidural hematoma. * p<0.05.

• 

  Fig. 3 Kaplan–Meier curve with log-rank test showing survival probability within 30 days of surgery, based on initial accompanying brain injury. CI: conÿdence interval, TICH: traumatic intracerebral hematoma, tSAH: traumatic subarachnoid hemorrhage, IVH: intraventricular blood, EDH: epidural hematoma.

• 

  Fig. 4 Kaplan–Meier curve with log-rank test showing survival probability within 30 days of surgery based on clinical and radiologic factors. GCS: Glasgow coma scale, SDH: subdural hematoma, SIH: stress-induced hyperglycemia.

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  Fig. 5 Multivariate hazard ratios of clinical and radiologic factors associated with 30-day mortality after surgery. HR: hazard ratio, CI: confidence interval, tSAH: traumatic subarachnoid hemorrhage, SIH: stress-induced hyperglycemia, GCS: Glasgow coma scale. *p<0.01, †p<0.05, ‡p<0.001.

Reference

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