1
|
Rickard F, Gale J, Williams A, Shipway D. New horizons in subdural haematoma. Age Ageing 2023; 52:afad240. [PMID: 38167695 DOI: 10.1093/ageing/afad240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Indexed: 01/05/2024] Open
Abstract
Subdural haematoma (SDH) is a common injury sustained by older people living with frailty and multimorbidity, and typically following falls from a standing height. Anticoagulant and antiplatelet use are commonly indicated in older people with SDH, but few data inform decision-making surrounding these agents in the context of intracranial bleeding. Opposing risks of rebleeding and thrombosis must therefore be weighed judiciously. Decision-making can be complex and requires detailed awareness of the epidemiology to ensure the safest course of action is selected for each patient. Outcomes of surgical decompression in acute SDH are very poor in older people. However, burr hole drainage can be safe and effective in older adults with symptomatic chronic SDH (cSDH). Such patients need careful assessment to ensure symptoms arise from cSDH and not from coexisting medical pathology. Furthermore, the emerging treatment of middle meningeal artery embolisation offers a well-tolerated, minimally invasive intervention which may reduce the risks of rebleeding in older adults. Nonetheless, UK SDH management is heterogenous, and no accepted UK or European guidelines exist at present. Further randomised trial evidence is required to move away from clinical practice based on historic observational data.
Collapse
Affiliation(s)
- Frances Rickard
- Consultant Geriatrician, Geriatric Major Trauma, North Bristol NHS Trust, Bristol, UK
| | - John Gale
- Clinical Fellow in Geriatric Major Trauma, North Bristol NHS Trust, Bristol, UK
| | - Adam Williams
- Consultant Neurosurgeon, Department of Neurosurgery, North Bristol NHS Trust, Bristol, UK
| | - David Shipway
- Consultant Geriatrician, Geriatric Major Trauma, North Bristol NHS Trust, Bristol, UK
- Honorary Senior Clinical Lecturer, University of Bristol, Bristol, UK
| |
Collapse
|
2
|
Aljabali A, Sharkawy AM, Jaradat B, Serag I, Al-Dardery NM, Abdelhady M, Abouzid M. Drainage versus no drainage after burr-hole evacuation of chronic subdural hematoma: a systematic review and meta-analysis of 1961 patients. Neurosurg Rev 2023; 46:251. [PMID: 37726502 PMCID: PMC10509130 DOI: 10.1007/s10143-023-02153-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
Chronic subdural hematoma (cSDH) is a common neurosurgical condition that can cause severe morbidity and mortality. cSDH recurs after surgical evacuation in 5-30% of patients, but drains may help reduce this risk. We aimed to investigate the effect of drainage versus no drainage on the rates of recurrence and mortality, as well as the clinical outcomes of cSDH. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched four electronic databases (PubMed, Cochrane Library, Scopus, and Web of Science) to identify eligible studies reported up to June 2022. Using Review Manager software, we reported four primary outcomes as odds ratios (ORs) and confidence intervals (CIs). The meta-analysis included a total of 10 studies with 1961 patients. The use of drainage was found to be significantly more effective than non-drainage in reducing the "mortality rate" (OR = 0.65, 95% CI 0.43 to 0.97; P = 0.04), the "recurrence rate" (OR = 0.39, 95% CI 0.28 to 0.55; P < 0.00001), and occurrence of "gross focal neurological deficit" (OR = 0.58, 95% CI 0.37 to 0.89; P = 0.01). No significant difference was found in the occurrence of a Glasgow Coma Scale score of 15 (OR = 1.21, 95% CI 0.84 to 1.76; P = 0.30). The use of drains after burr-hole irrigation reduces the recurrence, mortality, and gross focal neurological deficit rates of chronic subdural hematomas.
Collapse
Affiliation(s)
- Ahmed Aljabali
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
- Medical Research Group of Egypt, Negida Academy, Arlington, MA, USA
| | - Aya Mohammed Sharkawy
- Medical Research Group of Egypt, Negida Academy, Arlington, MA, USA
- Faculty of Medicine, South Valley University, Qena, Egypt
| | - Belal Jaradat
- Medical Research Group of Egypt, Negida Academy, Arlington, MA, USA
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Ibrahim Serag
- Medical Research Group of Egypt, Negida Academy, Arlington, MA, USA
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nada Mostafa Al-Dardery
- Medical Research Group of Egypt, Negida Academy, Arlington, MA, USA
- Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Mariam Abdelhady
- Medical Research Group of Egypt, Negida Academy, Arlington, MA, USA
- Faculty of Medicine, October 6 University, Giza, Egypt
| | - Mohamed Abouzid
- Department of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3 St., 60-806, Poznan, Poland.
- Doctoral School, Poznan University of Medical Sciences, 60-812, Poznan, Poland.
| |
Collapse
|