Medical Student Albert Einstein College of Medicine Morris Plains, New Jersey, United States
Introduction: Subdural hematoma (SDH) represents one of the most common types of intracranial hemorrhages, particularly in the elderly. Despite long history of diagnoses and procedure, there is conflicting data on the parameters to predict outcomes.
Methods: We conducted a large retrospective review of patients that underwent a SDH evacuation at a single urban institution between 2015-2022. Data were collected from the electronic medical record on prior comorbidities, anticoagulation use, mental status on presentation, pre-op labs, and pre/post-op imaging parameters. Univariate and multivariate analyses were conducted to analyze predictors of mortality.
Results: Of the 329 patients who underwent evacuation of subdural hematoma, 35 were excluded due to missing data in the EMR. Mortality during admission for this cohort was 11%. Univariate analysis showed the mortality rate was higher in those presenting with an acute SDH. In addition, those who presented with altered mental status, weakness, drift, or intubated had higher rates of mortality (POM). Patients who had a lower score on the Glasgow Coma Scale (GCS) had higher rates of POM. Prior use of the anticoagulants Plavix, Effient, Brilinta, Integrilin, or Coumadin was correlated with higher POM. Examination of pre-op labs showed that patients who presented with anemia or hypoalbuminemia had higher POM. Imaging data showed that a larger mid-line shift on presentation and a larger post-op shift were correlated with higher rates of POM. Multivariate analysis showed that altered mental status and being intubated on presentation, pre-op anemia, prior coumadin use, and the acute SDH were correlated with a higher risk of mortality.
Conclusion : We demonstrated that patients presenting with altered mental status, being intubated on presentation, patients with anemia, those with prior coumadin use, and the ones with acute subdural have a higher risk of mortality when presenting for a SDH evacuation. Interestingly patient’s age did not have an impact on mortality.
