Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Acta Neurochirurgica
Published in: Acta Neurochirurgica 6/2020

Open Access 01-06-2020 | Subdural Hematoma | Original Article - Brain trauma

Long-term excess mortality after chronic subdural hematoma

Authors: Minna Rauhala, Pauli Helén, Karri Seppä, Heini Huhtala, Grant L. Iverson, Tero Niskakangas, Juha Öhman, Teemu M. Luoto

Published in: Acta Neurochirurgica | Issue 6/2020

Login to get access

Abstract

Objective

To assess possible long-term excess mortality and causes of death of patients with chronic subdural hematoma (CSDH).

Methods

A retrospective study (1990–2015) of adult patients (n = 1133, median age = 76 years old, men = 65%) with CSDH identified by ICD-codes and verified by medical records. All patients were followed until death or the end of 2017. Cumulative relative survival ratios and relative excess risks of death (RER) were estimated by comparing patients’ mortality with that in the entire regional matched population. The causes of death were compared with a separate reference group formed by randomly choosing sex, age, and calendar time matched controls (4 controls per each CSDH patient).

Results

The median follow-up time was 4.8 years (range = 0–27 years), and 710 (63%) of the patients died (median age at death = 84 years old). The cumulative excess mortality was 1 year = 9%, 5 years = 18%, 10 years = 27%, 15 years = 37%, and 20 years = 48%. A subgroup of CSDH patients (n = 206) with no comorbidity had no excess mortality. Excess mortality was related to poor modified Rankin score at admission (RER = 4.93) and at discharge (RER = 8.31), alcohol abuse (RER = 4.47), warfarin (RER = 2.94), age ≥ 80 years old (RER = 1.83), non-operative treatment (RER = 1.56), and non-traumatic etiology (RER = 1.69). Hematoma characteristics or recurrence were unrelated to excess mortality. Dementia was the most common cause of death among the CSDH patients (21%) and the third most common cause in the reference group (15%, p < 0.001).

Conclusions

Patients with CSDH have continuous excess mortality up to 20 years after diagnosis. Patient-related characteristics have a strong association with excess mortality, whereas specific CSDH-related findings do not. CSDH patients have an increased risk for dementia-related mortality.
Literature
1.
Adhiyaman V, Asghar M, Ganeshram KN, Bhowmick BK (2002) Chronic subdural haematoma in the elderly. Postgrad Med J 78:71–75CrossRef
2.
Alves JL, Santiago JG, Costa G, Mota Pinto A (2016) A standardized classification for subdural hematomas- I. Am J Forensic Med Pathol 37:174–178CrossRef
3.
Bartek J Jr, Sjavik K, Stahl F, Kristiansson H, Solheim O, Gulati S, Sagberg LM, Forander P, Jakola AS (2017) Surgery for chronic subdural hematoma in nonagenarians: a Scandinavian population-based multicenter study. Acta Neurol Scand 136:516–520CrossRef
4.
Bin Zahid A, Balser D, Thomas R, Mahan MY, Hubbard ME, Samadani U (2018) Increase in brain atrophy after subdural hematoma to rates greater than associated with dementia. J Neurosurg 1–9
5.
Chapleau M, Aldebert J, Montembeault M, Brambati SM (2016) Atrophy in Alzheimer’s disease and semantic dementia: an ALE meta-analysis of voxel-based morphometry studies. J Alzheimers Dis 54:941–955CrossRef
6.
Connolly BJ, Pearce LA, Hart RG (2014) Vitamin K antagonists and risk of subdural hematoma: meta-analysis of randomized clinical trials. Stroke 45:1672–1678CrossRef
7.
Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D, Burant CJ, Landefeld CS (2003) Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc 51:451–458CrossRef
8.
De Bonis P, Trevisi G, de Waure C, Sferrazza A, Volpe M, Pompucci A, Anile C, Mangiola A (2013) Antiplatelet/anticoagulant agents and chronic subdural hematoma in the elderly. PLoS One 8:e68732CrossRef
9.
Di Castelnuovo A, Costanzo S, Bagnardi V, Donati MB, Iacoviello L, de Gaetano G (2006) Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. Arch Intern Med 166:2437–2445CrossRef
10.
Dickman PW, Sloggett A, Hills M, Hakulinen T (2004) Regression models for relative survival. Stat Med 23:51–64CrossRef
11.
Dumont TM, Rughani AI, Goeckes T, Tranmer BI (2013) Chronic subdural hematoma: a sentinel health event. World Neurosurg 80:889–892CrossRef
12.
Echlin F (1949) Traumatic subdural hematoma; acute, subacute and chronic; an analysis of 70 operated cases. J Neurosurg 6:294–303CrossRef
13.
Ederer F HH (1959) Instructions to IBM 650 programmers in processing survival computations. Methodological note no. 10. Bethesda, MD end results Eval sect Natl Cancer Inst 1959
14.
Edlmann E, Giorgi-Coll S, Whitfield PC, Carpenter KLH, Hutchinson PJ (2017) Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation 14:108-017-0881-yCrossRef
15.
Gaist D, Garcia Rodriguez LA, Hellfritzsch M, Poulsen FR, Halle B, Hallas J, Pottegard A (2017) Association of antithrombotic drug use with subdural hematoma risk. JAMA 317:836–846CrossRef
16.
Guilfoyle MR, Hutchinson PJ, Santarius T (2017) Improved long-term survival with subdural drains following evacuation of chronic subdural haematoma. Acta Neurochir 159:903–905CrossRef
17.
He W, Goodkind D, Kowal P (2016) U.S. Census Bureau, International Population Reports, P95/16–1, An Aging World: 2015. U.S. Government Publishing Office, Washington, DC
18.
Iorio-Morin C, Touchette C, Levesque M, Effendi K, Fortin D, Mathieu D (2018) Chronic subdural hematoma: toward a new management paradigm for an increasingly complex population. J Neurotrauma 35:1882–1885CrossRef
19.
Jones S, Kafetz K (1999) A prospective study of chronic subdural haematomas in elderly patients. Age Ageing 28:519–521CrossRef
20.
Keeler E, Guralnik JM, Tian H, Wallace RB, Reuben DB (2010) The impact of functional status on life expectancy in older persons. J Gerontol A Biol Sci Med Sci 65:727–733CrossRef
21.
Kpelao E, Beketi KA, Moumouni AK, Doleagbenou A, Ntimon B, Egbohou P, Mouzou T, Tomta K, Sama DH, Abalo A, Walla A, Dossim A (2016) Clinical profile of subdural hematomas: dangerousness of subdural subacute hematoma. Neurosurg Rev 39:237–240 discussion 240CrossRef
22.
Lee KS (2016) Chronic subdural hematoma in the aged, trauma or degeneration? J Korean Neurosurg Soc 59:1–5CrossRef
23.
Lindvall P, Koskinen LO (2009) Anticoagulants and antiplatelet agents and the risk of development and recurrence of chronic subdural haematomas. J Clin Neurosci 16:1287–1290CrossRef
24.
Liu H, Yang Y, Xia Y, Zhu W, Leak RK, Wei Z, Wang J, Hu X (2017) Aging of cerebral white matter. Ageing Res Rev 34:64–76CrossRef
25.
Manickam A, Marshman LA, Johnston R (2016) Long-term survival after chronic subdural haematoma. J Clin Neurosci 34:100–104CrossRef
26.
Markwalder TM (1981) Chronic subdural hematomas: a review. J Neurosurg 54:637–645CrossRef
27.
Maurice-Williams RS (1999) Chronic subdural haematoma: an everyday problem for the neurosurgeon. Br J Neurosurg 13:547–549CrossRef
28.
Mehta V, Harward SC, Sankey EW, Nayar G, Codd PJ (2018) Evidence based diagnosis and management of chronic subdural hematoma: a review of the literature. J Clin Neurosci 50:7–15CrossRef
29.
Miranda LB, Braxton E, Hobbs J, Quigley MR (2011) Chronic subdural hematoma in the elderly: not a benign disease. J Neurosurg 114:72–76CrossRef
30.
Nathan S, Goodarzi Z, Jette N, Gallagher C, Holroyd-Leduc J (2017) Anticoagulant and antiplatelet use in seniors with chronic subdural hematoma: systematic review. Neurology 88:1889–1893CrossRef
31.
Prince M, Wimo A, Ali G, Wu Y, Prina M (2015) World Alzheimer Report 2015: the global impact of dementia: an analysis of prevalence, incidence, cost and trends. Alzheimer’s Disease International, London
32.
Rauhala M, Luoto TM, Huhtala H, Iverson GL, Niskakangas T, Ohman J, Helen P (2019) The incidence of chronic subdural hematomas from 1990 to 2015 in a defined Finnish population. J Neurosurg 1–11
33.
Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P, Richards HK, Marcus H, Parker RA, Price SJ, Kirollos RW, Pickard JD, Hutchinson PJ (2009) Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet 374:1067–1073CrossRef
34.
Seppa K, Hakulinen T, Laara E, Pitkaniemi J (2016) Comparing net survival estimators of cancer patients. Stat Med 35:1866–1879CrossRef
35.
Shapey J, Glancz LJ, Brennan PM (2016) Chronic subdural haematoma in the elderly: is it time for a new paradigm in management? Curr Geriatr Rep 5:71–77CrossRef
36.
Whitfield JB, Heath AC, Madden PAF, Landers JG, Martin NG (2018) Effects of high alcohol intake, alcohol-related symptoms and smoking on mortality. Addiction 113:158–166CrossRef
37.
Yang AI, Balser DS, Mikheev A, Offen S, Huang JH, Babb J, Rusinek H, Samadani U (2012) Cerebral atrophy is associated with development of chronic subdural haematoma. Brain Inj 26:1731–1736CrossRef
38.
Yang W, Huang J (2017) Chronic subdural hematoma: epidemiology and natural history. Neurosurg Clin N Am 28:205–210CrossRef
Metadata
Title
Long-term excess mortality after chronic subdural hematoma
Authors
Minna Rauhala
Pauli Helén
Karri Seppä
Heini Huhtala
Grant L. Iverson
Tero Niskakangas
Juha Öhman
Teemu M. Luoto
Publication date
01-06-2020
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 6/2020
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-020-04278-w

Other articles of this Issue 6/2020

Acta Neurochirurgica 6/2020 Go to the issue

Review Article - Vascular Neurosurgery - Aneurysm

Size of ruptured intracranial aneurysms: a systematic review and meta-analysis

Original Article - Neurosurgical intensive care

Hypozincaemia is associated with severity of aneurysmal subarachnoid haemorrhage: a retrospective cohort study

Original Article - Peripheral Nerves

Quality of life effects of pain from para-lumbar- and lower extremity entrapment syndrome and carpal tunnel syndrome and comparison of the effectiveness of surgery

Original Article - Pituitaries

Predicting post-operative cerebrospinal fluid (CSF) leak following endoscopic transnasal pituitary and anterior skull base surgery: a multivariate analysis

Editorial (by Invitation)

Adult spine deformity surgery—what do we miss?

Letter to the editor - Vascular Neurosurgery - Ischemia

Letter to the Editor regarding STA-MCA bypass via retrograde arterial anastomosis in a patient with common carotid artery occlusion: a case report