Lalith Premachandra, MD
CHRISTUS Mother Frances Hospital Tyler
Tyler, Texas
Disclosure information not submitted.
Title: Seizures After Acute Subdural Hematoma: Incidence, Risk Factors, and Outcomes
Introduction: Subdural hematoma (SDH) puts patients at increased risk of seizures. Although this association has been reported in numerous studies, the epidemiology remains poorly understood. The purpose of this study was to evaluate the incidence, risk factors, and outcome of seizures in patients with acute SDH.
Methods: We performed a retrospective review of patients admitted with SDH to our NeuroICU between 1/2012 and 03/2021. The following data were collected from EHR: Age in years, gender, Glasgow coma score (GCS) on admission, APACHE IV score (acute physiologic and chronic health evaluation), traumatic (T) vs spontaneous, antiplatelet therapy (APT), anticoagulant therapy (AC), indication for surgery based on guidelines (a thickness greater than 10 mm [OR1] or a midline shift (MLS) greater than 5 mm on CT [OR2], GCS < 9 and SDH less than 10-mm thick and a MLS < 5 if GCS drops by more than 2 points between time of injury and hospital admission [OR3], or asymmetric or fixed and dilated pupil [OR4]), and percentage who underwent neurosurgery (NSG). Outcome was evaluated at hospital discharge on the modified Rankin scale (range, 0 [normal] to 6 [death]) with 0 – 3 considered as good functional outcome) as well as length of stay (LOS, days).
Results: We identified a total of 322 patients. 38 patients (11.8 %) developed seizures (S group) compared to 284 patients (88.2 %) without seizures (NS group). Compared to the NS group, the S group had similar age (71 +/- 17 vs 72 +/- 14, p = 0.7), similar % male (55% vs 62%, p = 0.4), similar GCS (13.2 +/- 2.9 vs 13.7 +/- 2.8, p = 0.3), similar APACHE ( 52 +/- 21 vs 47 +/- 20, p = 0.2), similar T (39% vs 41%, p = 0.8), similar APT (55 % vs 43 %, p = 0.2) and AC (21% vs 23 %, p = 0.8), lower OR1 (50% vs 74 %, p = 0.002) , similar OR2 (37 % vs 46 %, p = 0.3), similar OR3 (0 % vs 1 %, p = 0.5), similar OR4 (2.6 % vs 4.2 %, p = 0.6), similar NSG (45% vs 56%, p = 0.2), longer hospital LOS ( 10.6 +/- 9.6 vs 6.5 +/- 5.8, p = 0.0002), and worse functional outcome (mRS 0-3, 58% vs 79%, p = 0.004).
Conclusion: Patients with SDH who developed seizures had similar characteristics to those who did not. Seizures are an independent risk factor for worse outcomes and longer length of stays. These findings should be investigated in large multicenter prospective studies.