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Champeaux Depond C, El Hairech D, Metellus P. Super acute subdural hematoma following drain removal for chronic subdural haematoma. Neurochirurgie 2024; 70:101510. [PMID: 37976803 DOI: 10.1016/j.neuchi.2023.101510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Charles Champeaux Depond
- Department of Neurosurgery, Clairval Private Hospital, 317 Bd du Redon, 13 009 Marseille, France.
| | - Dahmane El Hairech
- Department of Neurosurgery, Clairval Private Hospital, 317 Bd du Redon, 13 009 Marseille, France
| | - Philippe Metellus
- Department of Neurosurgery, Clairval Private Hospital, 317 Bd du Redon, 13 009 Marseille, France; Institut de Neurophysiopathologie - CNRS UMR 7051, Aix-Marseille Université, Marseille, France
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Teshita G, Wondafrash M, G/Egziabher B, Getachew B, Bergene E. Clinical characteristics and functional outcome of surgically treated adult head trauma patients with acute subdural hematoma: Ethiopian tertiary hospitals experience. World Neurosurg X 2024; 21:100264. [PMID: 38260115 PMCID: PMC10801322 DOI: 10.1016/j.wnsx.2023.100264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/29/2023] [Accepted: 11/28/2023] [Indexed: 01/24/2024] Open
Abstract
Background Acute subdural hematoma (ASDH) is one of the most common and devastating lesions in traumatic brain injury with a mortality rate upto 60 % especially in low-income countries. The present study aimed to determine the clinical characteristics and functional outcomes and the associated factors of surgically treated head trauma patients with ASDH. Methods Between January 2018 and January 2021 we identified 140 head trauma patients with ASDH who underwent surgical evacuation in three tertiary hospitals. Epidemiological data were collected; the six-month functional outcome was studied using an extended Glasgow outcome score (EGOS) and associated factors were also studied. Univariate analysis was performed at first, and variables with a P-value of <0.05 were entered into the multivariable logistic regression model. Results Male predominance was seen accounting for 87 % and assault was the most common mechanism of injury (35.7 %). Sixty-five (56.5 %) of patients achieved favorable functional recovery (EGOS of 5-8) and 50 (43.5 %) of patients had unfavorable recovery (EGOS of 1-4) after 6 months of follow-up. In multivariate logistic regression models, GCS <5, Pupillary abnormality, hypotension, oxygen saturation <90 at presentation, and hospital-acquired pneumonia were the independent factors associated with unfavorable functional outcomes. Conclusion In our setup, most of the patients are male from assault injuries. There is still a high rate of unfavorable outcomes in patients with acute subdural hematoma. GCS <5, pupillary abnormality, hypotension and desaturation at presentation, and postoperative hospital-acquired infection are predictors for unfavorable functional outcomes.
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Affiliation(s)
- Gemechu Teshita
- Department of Neurosurgery, Minilik Referral Hospital, Addis Ababa, Ethiopia
| | - Mulualem Wondafrash
- Department of Neurosurgery, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Biniam G/Egziabher
- Department of Neurosurgery, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Biruk Getachew
- Department of Neurosurgery, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Eyerusalem Bergene
- Department of Neurosurgery, Saint Paul's Millennium Medical College, Addis Ababa, Ethiopia
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Fluss R, Ryvlin J, Lam S, Abdullah M, Altschul DJ. Deadliness of Traumatic Subdural Hematomas in the First Quarter of the Year: A Measurement by the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). Cureus 2023; 15:e50860. [PMID: 38249271 PMCID: PMC10798905 DOI: 10.7759/cureus.50860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Background Traumatic acute subdural hematoma (ASDH) is a surgical emergency and has been associated with high morbidity and mortality. However, it is not known whether mortality from ASDH occurs more frequently in a particular season. Methodology We queried the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) from 2016 to 2019. They were identified in the NSQIP using the International Classification of Diseases (ICD-10) code S06.5 to capture all admissions with a primary diagnosis of traumatic subdural hematoma. Mortality rates were reviewed per season, defined as three consecutive months in the year. Demographics such as age, race, ethnicity, height, and weight were reviewed. Comorbidities such as diabetes, risk factors, including smoking history, and hospitalization characteristics, such as admission year, operation year, and inpatient/outpatient treatment type, were also reviewed. Results A total of 1,656 patients were included in this study. The mean age of all participants was 70.6 years, with 37% (604/1,656) being female. The mortality rate was highest in January, February, and March at 24.5% (104/425, P = 0.045) of admitted patients compared to mortality rates of 18.8% (70/373) in April to June, 18.4% (81/441) in July to September, and 17.5% (73/417) in October to December. Conclusions Mortality is significantly greater during the winter months of January, February, and March among patients with ASDH. Despite better survival rates of ASDH over the past two decades, postoperative mortality rates still remain high.
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Affiliation(s)
- Rose Fluss
- Neurological Surgery, Montefiore Medical Center, Bronx, USA
| | - Jessica Ryvlin
- Neurological Surgery, Albert Einstein College of Medicine, Bronx, USA
| | - Sharon Lam
- Neurological Surgery, Albert Einstein College of Medicine, Bronx, USA
| | - Muhammad Abdullah
- Neurological Surgery, Albert Einstein College of Medicine, Bronx, USA
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Vychopen M, Hamed M, Bahna M, Racz A, Ilic I, Salemdawod A, Schneider M, Lehmann F, Eichhorn L, Bode C, Jacobs AH, Behning C, Schuss P, Güresir E, Vatter H, Borger V. A Validation Study for SHE Score for Acute Subdural Hematoma in the Elderly. Brain Sci 2022; 12:981. [PMID: 35892422 PMCID: PMC9330492 DOI: 10.3390/brainsci12080981] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/10/2022] [Accepted: 07/18/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE The aim of this study was the verification of the Subdural Hematoma in the Elderly (SHE) score proposed by Alford et al. as a mortality predictor in patients older than 65 years with nontraumatic/minor trauma acute subdural hematoma (aSDH). Additionally, we evaluated further predictors associated with poor outcome. METHODS Patients were scored according to age (1 point is given if patients were older than 80 years), GCS by admission (1 point for GCS 5-12, 2 points for GCS 3-4), and SDH volume (1 point for volume 50 mL). The sum of points determines the SHE score. Multivariate logistic regression analysis was performed to identify additional independent risk factors associated with 30-day mortality. RESULTS We evaluated 131 patients with aSDH who were treated at our institution between 2008 and 2020. We observed the same 30-day mortality rates published by Alford et al.: SHE 0: 4.3% vs. 3.2%, p = 1.0; SHE 1: 12.2% vs. 13.1%, p = 1.0; SHE 2: 36.6% vs. 32.7%, p = 0.8; SHE 3: 97.1% vs. 95.7%, p = 1.0 and SHE 4: 100% vs. 100%, p = 1.0. Additionally, 18 patients who developed status epilepticus (SE) had a mortality of 100 percent regardless of the SHE score. The distribution of SE among the groups was: 1 for SHE 1, 6 for SHE 2, 9 for SHE 3, and 2 for SHE 4. The logistic regression showed the surgical evacuation to be the only significant risk factor for developing the seizure. All patients who developed SE underwent surgery (p = 0.0065). Furthermore, SHE 3 and 4 showed no difference regarding the outcome between surgical and conservative treatment. CONCLUSIONS SHE score is a reliable mortality predictor for minor trauma acute subdural hematoma in elderly patients. In addition, we identified status epilepticus as a strong life-expectancy-limiting factor in patients undergoing surgical evacuation.
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Affiliation(s)
- Martin Vychopen
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (M.B.); (I.I.); (A.S.); (M.S.); (P.S.); (E.G.); (H.V.); (V.B.)
| | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (M.B.); (I.I.); (A.S.); (M.S.); (P.S.); (E.G.); (H.V.); (V.B.)
| | - Majd Bahna
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (M.B.); (I.I.); (A.S.); (M.S.); (P.S.); (E.G.); (H.V.); (V.B.)
| | - Attila Racz
- Department of Epileptology, University Hospital Bonn, 53127 Bonn, Germany;
| | - Inja Ilic
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (M.B.); (I.I.); (A.S.); (M.S.); (P.S.); (E.G.); (H.V.); (V.B.)
| | - Abdallah Salemdawod
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (M.B.); (I.I.); (A.S.); (M.S.); (P.S.); (E.G.); (H.V.); (V.B.)
| | - Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (M.B.); (I.I.); (A.S.); (M.S.); (P.S.); (E.G.); (H.V.); (V.B.)
| | - Felix Lehmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany; (F.L.); (L.E.); (C.B.)
| | - Lars Eichhorn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany; (F.L.); (L.E.); (C.B.)
| | - Christian Bode
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany; (F.L.); (L.E.); (C.B.)
| | - Andreas H. Jacobs
- Department of Geriatric Medicine and Neurology, Johanniter Hospital Bonn, 53113 Bonn, Germany;
| | - Charlotte Behning
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, 53127 Bonn, Germany;
| | - Patrick Schuss
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (M.B.); (I.I.); (A.S.); (M.S.); (P.S.); (E.G.); (H.V.); (V.B.)
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (M.B.); (I.I.); (A.S.); (M.S.); (P.S.); (E.G.); (H.V.); (V.B.)
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (M.B.); (I.I.); (A.S.); (M.S.); (P.S.); (E.G.); (H.V.); (V.B.)
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (M.B.); (I.I.); (A.S.); (M.S.); (P.S.); (E.G.); (H.V.); (V.B.)
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