Introduction: Previous studies have demonstrated high in-hospital mortality rates in elderly patients with acute subdural hematoma. Post-discharge mortality information is limited. We present both short and long-term mortality data and review the impact of associated comorbidities.
Methods: We retrospectively identified patients who had presented with isolated acute subdural hematomas after trauma during a 6 year period using our Data Registry. The National Social Security Death Index was then cross-referenced to obtain 7 year post-discharge mortality information on those patients, and Kaplan-Meier plots were utilized to analyze differences in survival rates. United States life tables were used to match demographics for peer-controlled actuarial comparisons. Univariate, Fisher’s test, and logistic regression analyses were used to assess the effects of multiple variables on survival.
Results: A total of 455 patients were included, of which 55.2% were considered geriatric (age =65). Fisher’s analysis demonstrated a significantly elevated in-hospital mortality rate in the geriatric group (p=0.0097). Analysis demonstrated a stepwise decrease in late survival, and overall survival, with increasing age (p<0.001 for both). The differences in late survival were most pronounced in the first year (p=.0231). Furthermore, as compared to peer-matched controls, our injured geriatric patients had a significantly lower survival rate for the first 4.5 years after discharge. Surgical decompression was associated with increased in-hospital mortality ( p=0.0145), and pre-admission antiplatelet/anticoagulant use was associated with a decreased late survival (p<0.001). Geriatric patients were more likely to have been injured as a result of a fall (p=0.0031).
Conclusions: Elderly patients who sustain acute subdural hematoma are subject to poor survival rates both in-hospital and long after discharge. Surgical evacuation is clearly not a panacea, and the poor outcomes are compounded by the ubiquitous employment of anti-platelet/anti-coagulant use. It would seem that once the ball is set into motion by the sustaining of such an injury, many of the elderly are locked into a course of progressive if not precipitous decline to death. Prevention thus seems to be of singular importance. Seeing that falls are the principal cause of these injuries, a large-scale focus on falls in the elderly and their prevention seems warranted.
Patient Care: This paper underscores the miserable outcomes that can be expected for elderly patients who sustain subdural hematoma. It focuses on the long-term impact on survival and suggests that the best intervention is prevention. A greater focus on fall prevention may have a profound influence on the well-being of this patient population.
Learning Objectives: To understand the impact of subdural hematoma in the elderly population.
to understand that subdural hematoma affects a higher mortality rate in the elderly long after hospital discharge.
To understand that fall prevention may be the most efficacious method of mitigating the impact of this dreadful injury.