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The impact of age, gender, acuteness and etiology on short-term clinical outcome in patients with subdural hematomas - international dual-center study

Kehayov Ivo (Sveti Georgi University Hospital, Medical University in Plovdiv, Clinic of Neurosurgery, Department of Neurosurgery, Plovdiv, Bulgaria)
Kostic Aleksandar (Clinical Center of Niš, Clinic for Neurosurgery, Niš)
Kitov Borislav (Sveti Georgi University Hospital, Medical University in Plovdiv, Clinic of Neurosurgery, Department of Neurosurgery, Plovdiv, Bulgaria)
Nikolov Vesna (Clinical Center of Niš, Clinic for Neurosurgery, Niš)
Zhelyazkov Hristo (Sveti Georgi University Hospital, Medical University in Plovdiv, Clinic of Neurosurgery, Department of Neurosurgery, Plovdiv, Bulgaria)
Davarski Atanas (Sveti Georgi University Hospital, Medical University in Plovdiv, Clinic of Neurosurgery, Department of Neurosurgery, Plovdiv, Bulgaria)

Introduction/Objective. Subdural hematoma is one of the most common intracranial types of bleeding with high risk of disability and mortality. The aim of this study was to determine the influence of age, sex, acuteness, and etiology of subdural hematoma on short-term clinical outcome in these patients. Methods. We retrospectively studied 288 patients who were diagnosed and operated on for subdural hematomas (SDH) with different etiology (traumatic and spontaneous) and acuteness (acute, subacute, and chronic) for a period of five years. Patients scored ≤ 5 points on the Glasgow Coma Scale at hospital admission were not included in this study. Clinical outcome was assessed by the modified Rankin Scale (mRS) score at hospital discharge. Descriptive statistics and logistic regression analysis were used to determine the effect of the investigated factors on short-term clinical outcome. Results. Logistic regression analysis was conducted to predict degree of recovery (good = mRS ≤1 vs. poor = mRS ≥ 2 or death) using sex, age, acuteness, and etiology of SDH as predictive factors. It was established that the following three factors made a significant contribution to the outcome: age (p = 0.004), acuteness (p < 0.001), and etiology of a hematoma (p = 0.023), with acuteness being the strongest predictive factor. Sex was not a significant predictor, while age under 70 years and spontaneous origin of SDH were associated with lower mRS scores and had a positive effect on recovery chances. Conclusion. Age, acuteness, and etiology of hematoma are important predictive factors that influence the short-term clinical outcome in patients with SDH. These parameters should be taken into account when giving prognosis for recovery chances to a patient’s family and relatives.

Keywords: subdural hematoma, outcome, predictive factors, recovery, surgery