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Open Access 01-12-2024 | Subdural Hematoma | Research

A proposed stratification system to address the heterogeneity of Subdural Hematoma Outcome reporting in the literature

Authors: Peyton L. Nisson, John Francis, Michelot Michel, Takuma Maeda, Chirag Patil

Published in: Neurosurgical Review | Issue 1/2024

Abstract

A major challenge within the academic literature on SDHs has been inconsistent outcomes reported across studies. Historically, patients have been categorized by the blood-product age identified on imaging (i.e., acute, subacute, or chronic). However, this schematic has likely played a central role in producing the heterogeneity encountered in the literature. In this investigation, a total of 494 patients that underwent SDH evacuation at a tertiary medical center between November 2013-December 2021 were retrospectively identified. Mechanism of injury was reviewed by the authors and categorized as either positive or negative for a high-velocity impact (HVI) injury. Any head strike injury leading to the formation of a SDH while traveling at a velocity beyond that of normal locomotion or daily activities was categorized as an HVI. Patients were subsequently stratified by those with an acute SDHs after a high-velocity impact (aSDHHVI), those with an acute SDH without a high-velocity impact injury (aSDHWO), and those with any combination of subacute or chronic blood products (mixed-SDH [mSDH]). Nine percent (n = 44) of patients experienced an aSDHHVI, 23% (n = 113) aSDHWO, and 68% (n = 337) mSDH. Between these groups, highly distinct patient populations were identified using several metrics for comparison. Most notably, aSDHHVI had a significantly worse neurological status at discharge (50% vs. 23% aSDHWO vs. 8% mSDH; p < 0.001) and mortality (25% vs. 8% aSDHWO vs. 4% mSDH; p < 0.001). Controlling for gender, midline shift (mm), and anticoagulation use in the acute SDH population, multivariable logistic regression revealed a 6.85x odds ratio (p < 0.001) for poor outcomes in those with a positive history for a high-velocity impact injury. As such, the distribution of patients that suffer an HVI related acute SDH versus those that do not can significantly affect the outcomes reported. Adoption of this stratification system will help address the heterogeneity of SDH reporting in the literature while still closely aligning with conventional reporting.

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Rao MG, Singh D, Vashista RK, Sharma SK (2016) Dating of Acute and Subacute Subdural Haemorrhage: a histo-pathological study. J Clin Diagn Res 10:Hc01–07. https://doi.org/10.7860/jcdr/2016/19783.8141CrossRefPubMedPubMedCentral

United Nations DoEaSA, Population Division (2019) World Population Prospects 2019: Methodology of the United Nations population estimates and projections (ST/ESA/SER. A/425)

Scotti G, Terbrugge K, Melançon D, Bélanger G (1977) Evaluation of the age of subdural hematomas by computerized tomography. J Neurosurg 47:311–315. https://doi.org/10.3171/jns.1977.47.3.0311CrossRefPubMed

Bergström M, Ericson K, Levander B, Svendsen P (1977) Computed tomography of cranial subdural and epidural hematomas: variation of attenuation related to time and clinical events such as rebleeding. J Comput Assist Tomogr 1:449–455. https://doi.org/10.1097/00004728-197710000-00011CrossRefPubMed

Karibe H, Hayashi T, Hirano T, Kameyama M, Nakagawa A, Tominaga T (2014) Surgical management of traumatic acute subdural hematoma in adults: a review. Neurol Med Chir (Tokyo) 54:887–894. https://doi.org/10.2176/nmc.cr.2014-0204CrossRefPubMed

Ng SY, Lee AYW (2019) Traumatic brain injuries: pathophysiology and potential therapeutic targets. Front Cell Neurosci 13:528. https://doi.org/10.3389/fncel.2019.00528CrossRefPubMedPubMedCentral

Akbik OS, Starling RV, Gahramanov S, Zhu Y, Lewis J (2019) Mortality and functional outcome in surgically evacuated Acute Subdural Hematoma in Elderly patients. World Neurosurg 126:e1235–e1241. https://doi.org/10.1016/j.wneu.2019.02.234CrossRefPubMed

Monsivais D, Choi HA, Kitagawa R, Franch M, Cai C (2018) A retrospective analysis of surgical outcomes for acute subdural hematoma in an elderly cohort. Interdisciplinary Neurosurg 14:130–134. https://doi.org/10.1016/j.inat.2018.07.010CrossRef

Benedetto N, Gambacciani C, Montemurro N, Morganti R, Perrini P (2017) Surgical management of acute subdural haematomas in elderly: report of a single center experience. Br J Neurosurg 31:244–248. https://doi.org/10.1080/02688697.2016.1244249CrossRefPubMed

10.

Won SY, Dubinski D, Brawanski N et al (2017) Significant increase in acute subdural hematoma in octo- and nonagenarians: surgical treatment, functional outcome, and predictors in this patient cohort. Neurosurg Focus 43:E10. https://doi.org/10.3171/2017.7.Focus17417CrossRefPubMed

11.

Howard MA 3rd, Gross AS, Dacey RG Jr., Winn HR (1989) Acute subdural hematomas: an age-dependent clinical entity. J Neurosurg 71:858–863. https://doi.org/10.3171/jns.1989.71.6.0858

12.

Ryan CG, Thompson RE, Temkin NR, Crane PK, Ellenbogen RG, Elmore JG (2012) Acute traumatic subdural hematoma: current mortality and functional outcomes in adult patients at a Level I trauma center. J Trauma Acute Care Surg 73:1348–1354. https://doi.org/10.1097/TA.0b013e31826fcb30CrossRefPubMedPubMedCentral

13.

Manivannan S, Spencer R, Marei O et al (2021) Acute subdural haematoma in the elderly: to operate or not to operate? A systematic review and meta-analysis of outcomes following surgery. BMJ Open 11:e050786. https://doi.org/10.1136/bmjopen-2021-050786CrossRefPubMedPubMedCentral

14.

Younsi A, Fischer J, Habel C et al (2021) Mortality and functional outcome after surgical evacuation of traumatic acute subdural hematomas in octa- and nonagenarians. Eur J Trauma Emerg Surg 47:1499–1510. https://doi.org/10.1007/s00068-020-01419-9CrossRefPubMed

15.

Taussky P, Hidalgo ET, Landolt H, Fandino J (2012) Age and salvageability: analysis of outcome of patients older than 65 years undergoing craniotomy for acute traumatic subdural hematoma. World Neurosurg 78:306–311. https://doi.org/10.1016/j.wneu.2011.10.030CrossRefPubMed

16.

Hsieh CH, Rau CS, Wu SC et al (2018) Risk factors contributing to higher Mortality Rates in Elderly patients with Acute traumatic subdural hematoma sustained in a fall: a cross-sectional analysis using registered Trauma Data. Int J Environ Res Public Health 15. https://doi.org/10.3390/ijerph15112426

17.

McMillian WD, Rogers FB (2009) Management of prehospital antiplatelet and anticoagulant therapy in traumatic head injury: a review. J Trauma 66:942–950. https://doi.org/10.1097/TA.0b013e3181978e7bCrossRefPubMed

18.

Munivenkatappa A, Agrawal A, Shukla DP, Kumaraswamy D, Devi BI (2016) Traumatic brain injury: does gender influence outcomes? Int J Crit Illn Inj Sci 6:70–73. https://doi.org/10.4103/2229-5151.183024CrossRefPubMedPubMedCentral

19.

Farace E, Alves WM (2000) Do women fare worse? A metaanalysis of gender differences in outcome after traumatic brain injury. Neurosurg Focus 8:e6. https://doi.org/10.3171/foc.2000.8.1.152CrossRefPubMed

20.

Koç RK, Akdemir H, Öktem IS, Meral M, Menkü A (1997) Acute subdural hematoma: outcome and outcome prediction. Neurosurg Rev 20:239–244. https://doi.org/10.1007/BF01105894CrossRefPubMed

21.

Ushewokunze S, Nannapaneni R, Gregson BA, Stobbart L, Chambers IR, Mendelow AD (2004) Elderly patients with severe head injury in coma from the outset–has anything changed? Br J Neurosurg 18:604–607. https://doi.org/10.1080/02688690400022763CrossRefPubMed

22.

Christopher E, Poon MTC, Glancz LJ et al (2019) Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma. Neurosurg Rev 42:427–431. https://doi.org/10.1007/s10143-018-0979-4CrossRefPubMed

23.

Bocca LF, Lima JVF, Suriano IC, Cavalheiro S, Rodrigues TP (2021) Traumatic acute subdural hematoma and coma: retrospective cohort of surgically treated patients. Surg Neurol Int 12:424. https://doi.org/10.25259/sni_490_2021CrossRefPubMedPubMedCentral

24.

Sharma R, Rocha E, Pasi M, Lee H, Patel A, Singhal AB (2020) Subdural hematoma: predictors of Outcome and a score to Guide Surgical decision-making. J Stroke Cerebrovasc Dis 29:105180. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105180CrossRefPubMedPubMedCentral

25.

Stanišic M, Pripp AH (2017) A Reliable Grading System for Prediction of Chronic Subdural Hematoma Recurrence requiring Reoperation after initial Burr-Hole surgery. Neurosurgery 81:752–760. https://doi.org/10.1093/neuros/nyx090CrossRefPubMedPubMedCentral

26.

Shen J, Xin W, Li Q, Gao Y, Zhang J (2019) A Grading System for the prediction of unilateral chronic subdural hematoma recurrence after initial single Burr Hole Evacuation. Risk Manag Healthc Policy 12:179–188. https://doi.org/10.2147/rmhp.S222144CrossRefPubMedPubMedCentral

27.

Nisson PL, Francis JJ, Michel M, Goel K, Patil CG (2024) Extreme-aged patients (≥ 85 years) experience similar outcomes as younger geriatric patients following chronic subdural hematoma evacuation: a matched cohort study. GeroScience. https://doi.org/10.1007/s11357-024-01081-8CrossRefPubMed

28.

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 5:71–77. https://doi.org/10.1007/s13670-016-0166-9CrossRefPubMedPubMedCentral

29.

Petridis AK, Dörner L, Doukas A, Eifrig S, Barth H, Mehdorn M (2009) Acute subdural hematoma in the elderly; clinical and CT factors influencing the surgical treatment decision. Cent Eur Neurosurg 70:73–78. https://doi.org/10.1055/s-0029-1224096CrossRefPubMed

30.

Whitehouse KJ, Jeyaretna DS, Enki DG, Whitfield PC (2016) Head Injury in the Elderly: what are the outcomes of Neurosurgical Care? World Neurosurg 94:493–500. https://doi.org/10.1016/j.wneu.2016.07.057CrossRefPubMed

31.

Lavrador JP, Teixeira JC, Oliveira E, Simão D, Santos MM, Simas N (2018) Acute Subdural Hematoma Evacuation: predictive factors of Outcome. Asian J Neurosurg 13:565–571. https://doi.org/10.4103/ajns.AJNS_51_16CrossRefPubMedPubMedCentral

32.

Yagi T, Suzuki T, Nagata Y, Naruse H, Nakagawa O (1996) [The cases of acute spontaneous subdural hematoma]. No Shinkei Geka 24:665–669PubMed

33.

Akioka N, Fukuda O, Takaba M, Kameda H, Saito T, Endo S (2007) Clinical investigation of acute spontaneous subdural hematoma cases. J Stroke Cerebrovasc Dis 16:109–113. https://doi.org/10.1016/j.jstrokecerebrovasdis.2006.11.007CrossRefPubMed

34.

Garbossa D, Altieri R, Specchia FM et al (2014) Are acute subdural hematomas possible without head trauma? Asian J Neurosurg 9:218–222. https://doi.org/10.4103/1793-5482.146612CrossRefPubMedPubMedCentral

35.

de Noronha RJ, Sharrack B, Hadjivassiliou M, Romanowski CA (2003) Subdural haematoma: a potentially serious consequence of spontaneous intracranial hypotension. J Neurol Neurosurg Psychiatry 74:752–755. https://doi.org/10.1136/jnnp.74.6.752CrossRefPubMedPubMedCentral

36.

Galgano M, Toshkezi G, Qiu X, Russell T, Chin L, Zhao LR (2017) Traumatic Brain Injury: current treatment strategies and future endeavors. Cell Transpl 26:1118–1130. https://doi.org/10.1177/0963689717714102CrossRef

37.

Li M, Sirko S (2018) Traumatic Brain Injury: at the crossroads of Neuropathology and Common Metabolic endocrinopathies. J Clin Med 7. https://doi.org/10.3390/jcm7030059

38.

Armstead WM (2016) Cerebral blood Flow Autoregulation and Dysautoregulation. Anesthesiol Clin 34:465–477. https://doi.org/10.1016/j.anclin.2016.04.002CrossRefPubMedPubMedCentral

39.

Johnson VE, Stewart W, Smith DH (2013) Axonal pathology in traumatic brain injury. Exp Neurol 246:35–43. https://doi.org/10.1016/j.expneurol.2012.01.013CrossRefPubMed

40.

Gruenbaum BF, Zlotnik A, Fleidervish I, Frenkel A, Boyko M (2022) Glutamate Neurotoxicity and Destruction of the blood-brain barrier: key pathways for the development of Neuropsychiatric consequences of TBI and their potential treatment strategies. Int J Mol Sci 23. https://doi.org/10.3390/ijms23179628

41.

Leitgeb J, Mauritz W, Brazinova A et al (2012) Outcome after severe brain trauma due to acute subdural hematoma. J Neurosurg 117:324–333. https://doi.org/10.3171/2012.4.Jns111448CrossRefPubMed

42.

Miranda LB, Braxton E, Hobbs J, Quigley MR (2011) Chronic subdural hematoma in the elderly: not a benign disease. J Neurosurg 114:72–76. https://doi.org/10.3171/2010.8.Jns10298CrossRefPubMed

43.

Blaauw J, Jacobs B, Hertog HMD et al (2022) Mortality after chronic subdural hematoma is associated with frailty. Acta Neurochir (Wien) 164:3133–3141. https://doi.org/10.1007/s00701-022-05373-wCrossRefPubMed

44.

Biau DJ, Kernéis S, Porcher R (2008) Statistics in brief: the importance of sample size in the planning and interpretation of medical research. Clin Orthop Relat Res 466:2282–2288. https://doi.org/10.1007/s11999-008-0346-9CrossRefPubMedPubMedCentral

45.

Khorasani-Zavareh D, Bigdeli M, Saadat S, Mohammadi R (2015) Kinetic energy management in road traffic injury prevention: a call for action. J Inj Violence Res 7:36–37. https://doi.org/10.5249/jivr.v7i1.458CrossRefPubMedPubMedCentral

46.

Zheng J, Ouyang Y, Zhang K et al (2024) Early vs late fixation of extremity fractures among adults with traumatic brain Injury. JAMA Netw Open 7:e241556–e241556. https://doi.org/10.1001/jamanetworkopen.2024.1556CrossRefPubMedPubMedCentral

47.

Leitgeb J, Mauritz W, Brazinova A, Majdan M, Wilbacher I (2013) Impact of concomitant injuries on outcomes after traumatic brain injury. Arch Orthop Trauma Surg 133:659–668. https://doi.org/10.1007/s00402-013-1710-0CrossRefPubMedPubMedCentral

48.

Eliasziw M, Donner A (1991) Application of the McNemar test to non-independent matched pair data. Stat Med 10:1981–1991. https://doi.org/10.1002/sim.4780101211CrossRefPubMed

49.

Schober P, Vetter TR (2019) Chi-square tests in Medical Research. Anesth Analgesia 129:1193. https://doi.org/10.1213/ane.0000000000004410CrossRef

Title: A proposed stratification system to address the heterogeneity of Subdural Hematoma Outcome reporting in the literature
Authors: Peyton L. Nisson
John Francis
Michelot Michel
Takuma Maeda
Chirag Patil
Publication date: 01-12-2024
Publisher: Springer Berlin Heidelberg
Keywords: Subdural Hematoma
Central Nervous System Trauma
Published in: Neurosurgical Review / Issue 1/2024
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-024-02444-7

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A proposed stratification system to address the heterogeneity of Subdural Hematoma Outcome reporting in the literature

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