J Neurointensive Care.  2020 Oct;3(2):64-70. 10.32587/jnic.2020.00297.

Acute and Subacute Deterioration in Elderly Acute Subdural Hematoma Patients Who Were Initially Managed with Non-Surgical Treatment

• Lee SH
• Kim TW
• Shin HS
• Hwang YS
• Chung SY

• KMID: 2555041
• DOI: http://doi.org/10.32587/jnic.2020.00297

Abstract

Objective
We investigated the features and possible predictors of deterioration in the acute or subacute phase of acute subdural hematoma (ASDH) patients aged > 65 years who initially received conservative treatment.
Methods
Between January 2016 and December 2019, 184 patients with ASDH were treated in a single institution. Eighty-two patients aged ≥ 65 years who had initially presented with preserved neurological status and conservatively treated were included in this study. We classified patients into deterioration and non-deterioration groups according to whether deterioration occurred in the acute and subacute phases. Medical records and computed tomography scans were reviewed, retrospectively.
Results
Twelve out of 82 patients (14.6%) exhibited deterioration in the acute or subacute phase; the remaining 70 patients had not deteriorated in the acute and subacute phases. Clinical outcome at discharge was significantly worse in the deterioration group (p < 0.001) than in the non-deterioration group. The proportion of patients taking antithrombotics was significantly higher in the deteriorated patients (p = 0.003). In the deterioration group, the midline shift was more severe (p < 0.001), the hematoma was thicker (p = 0.001), and the proportion of mixed-density hematomas was higher (p < 0.001).
Conclusion
Even when elderly ASDH patients present with an initially good neurological status, acute or subacute deterioration is not uncommon. Maximum care should be paid to elderly patients under initial conservative management, especially those taking antithrombotics.

Keyword

Acute subdural hematoma; Elderly; Hematoma enlargement; Glasgow coma scale