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 a long history of diagnoses and procedures, there is conflicting data on predictive parameters for post-operative 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, mental status on presentation, pre-op labs, and pre/post-op imaging parameters. Patients were assigned a modified Rankin scale (mRS) score at discharge (favorable being 0-2 and unfavorable being 3-6). Univariate and multivariate analyses were performed to identify independent predictors of favorable functional outcomes.
Results: Of the 329 patients who underwent evacuation of subdural hematoma, 35 patients were excluded due to missing data in the EMR. 38% of the patients were discharged with a favorable mRS and 62% were discharged with an unfavorable mRS. Univariate analysis showed that those aged 75 and above, those presenting with a history of seizures, dementia, PVD, or dialysis had a higher mRS on discharge (mRSDC). Patients presenting with altered mental status and who were intubated had higher mRSDC. Patients with a higher Glasgow coma scale on admission were discharged having a higher mRS. Prior coumadin use and an elevated INR were associated with higher mRSDC. Imaging data showed that the greatest dimension of the SDH was correlated with a higher mRSDC. Multivariate analysis showed that only age over 75, history of dialysis, and altered mental status on presentation remained significant predictors for unfavorable mRS scores on discharge.
Conclusion : We demonstrated that older adults, patients who have a history of dialysis, and patients who have an altered mental status on presentation, have worse functional outcomes on discharge. Further analysis would be beneficial to better understand predictors of functional outcome in SDH patients.
