Outcomes of Subdural Hematoma in the Elderly with a History of Minor or No Previous Trauma

Abstract

Subdural hematoma (SDH) in the elderly is an increasingly common entity because of increased use of antithrombotic medications, an aging population, and increasing frequency of geriatric trauma. The present study describes the functional outcomes and mortality of SDH in an elderly population and to identify potential prognostic factors. Patients >65 years of age with SDH who were treated at our institution from 2005 to 2015 were identified. Patients with a history of preceding high-velocity trauma were excluded. Electronic medical records were retrospectively reviewed. The outcomes of interest were mortality, length of stay, and discharge Glasgow Outcome Score. A total of 671 patients were included in final statistical analyses. For patients with acute SDH, survival was 74.9%, 72.3%, and 69.8% at 30, 60, and 100 days, respectively. With respect to chronic SDH, survival was 87.0%, 83.7%, and 80.3% at 30, 60, and 100 days, respectively. On multivariate analysis, admission Glasgow Coma Scale (GCS) score was significantly predictive of mortality in both the acute and chronic populations. In the acute cohort, admission GCS score was a significant predictor of increased length of stay, whereas age >80 years, admission GCS score, contusion volume >10 cm3, SDH volume >50 cm3, and antiplatelet use were significant predictors of discharge functional status. SDH in the elderly carries high morbidity and mortality and several prognostic factors were identified. These results can be used to guide discussions with family regarding prognosis and perhaps aid in treatment decisions.