Introduction: Acute Subdural Hematoma of the Elderly (ASDHE) patient is a common Neurosurgical emergency, but there is limited data about long-term survival of these patients. Comorbidities previously associated with worse outcomes, especially anticoagulation, are prevalent in the elderly. There is a lack of data regarding how specific comorbidities and surgical interventions correlate with long-term survival, which complicates medical decision making.
Methods: Retrospective chart review of our Level 1 trauma center database identified 96 ASDHE patients between 2001-2012 with sufficient data regarding presenting exam, comorbidities, in-hospital treatment, and discharge disposition to meet inclusion criteria. Social security death index data was used to calculate length of survival post-discharge.
Results: Of the ASDHE patients admitted to our facility, 34/54(63%) of those treated non-surgically (NS) and 18/30(60%) treated with craniotomy (CR) survived their hospital stay (p=0.79). Average length of survival following discharge was 38.6 months (NS) versus 37.0 months (CR; p=0.88). Hematoma thickness averaged 8mm (NS survivors), 12mm (NS non-survivors), 12mm (CR survivors), 19.5mm (CR non-survivors). Length of stay for surviving patients was 5 days (NS) vs. 16 days (CR; p=0.006). The average presenting GCS of surviving patients was 13.8, compared to 7.8 for non-surviving patients, irrespective of intervention (p <0.001). All seven patients treated with burr holes survived hospitalization, after an average of 5.8 day hospitalization and average survival of 24.1 months post-discharge.
Conclusions: Surgically treated ASDHE patients are equally likely to survive hospitalization and survive for a comparable duration compared to patients treated non-surgically. The average thickness of SDH which was lethal in the nonsurgical group was identical to the average thickness of SDH in surviving craniotomy patients (12mm), though length of stay is significantly longer in survivors who underwent craniotomy. This data supports the potential for good surgical outcomes in appropriately selected ASDHE patients.
Patient Care: This data will assist physicians in appropriately selecting patients who are likely to benefit from surgical intervention and aid in discussion with family members seeking expertise about how to best treat their injured family members.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the factors which correlate to survival in ASDHE patients; 2) Discuss how and to whom these data should be applied to; 3) Identify an effective treatment plan for patients using outcome data gathered in this study.