Lalith Premachandra, MD
CHRISTUS Mother Frances Hospital Tyler
Tyler, Texas
Disclosure information not submitted.
Title: Factors Associated with Poor Outcomes in Patients with Acute Subdural Hematoma
Introduction: Subdural hematoma (SDH) is a common disease entity treated by neurosurgical intervention. The objective of this study is to identify factors associated with poor functional outcomes.
Methods: We performed a retrospective review of patients admitted with SDH to our ICU 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), new onset seizures (S), 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. 246 patients (76%) had good outcome (mRS 0-3, G group) compared to 76 patients (24%) had poor outcome (mRS 4-6, P group, p < 0.001). Compared to the G group, the P group had higher age (78 +/- 12 vs 70 +/- 14, p < 0.001), similar % female (38% vs 40%, p = 0.8), lower GCS (11.0 +/- 4.0 vs 14.5 +/- 1.4, p < 0.001), higher APACHE ( 67 +/- 12 vs 41 +/- 14, p < 0.001), similar T (42% vs 41%, p = 0.9), similar APT (54 % vs 42 %, p = 0.07) and AC (25% vs 22 %, p = 0.6), higher S (21 % vs 9 %, p = 0.005), similar OR1 (79% vs 69 %, p = 0.1) , higher OR2 (59 % vs 41 %, p = 0.006), similar OR3 (2.6 % vs 0.4 %, p = 0.08), higher OR4 (17.0 % vs 0.4 %, p = 0.08), similar NSG (53% vs 56%, p = 0.6), and longer hospital LOS ( 8.3 +/- 7 vs 6.6 +/- 6.3, p = 0.04).
Conclusion: Patients with SDH who had poor outcomes were older, had lower GCS, higher APACHE scores, more seizures, more percentage with a midline shift (MLS) greater than 5 mm, and with asymmetric or fixed and dilated pupils, and longer hospital LOS compared to those with good outcomes. These findings should be further investigated in large multicenter prospective studies.