Predictors of Functional Outcome After Subdural Hematoma: A Prospective Study
Background Although the incidence of subdural hematoma (SDH) has increased in the US in the last decade, limited prospective data exist examining risk factors for poor outcome. Methods A prospective, observational study of consecutive SDH patients was conducted from 7/2008 to 11/2011. Baseline clini...
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| description | Background
Although the incidence of subdural hematoma (SDH) has increased in the US in the last decade, limited prospective data exist examining risk factors for poor outcome.
Methods
A prospective, observational study of consecutive SDH patients was conducted from 7/2008 to 11/2011. Baseline clinical data, hospital and surgical course, complications, and imaging data were compared between those with good versus poor 3-month outcomes (modified Rankin Scores [mRS] 0–3 vs. 4–6). A multivariable logistic regression model was constructed to identify independent predictors of poor outcome.
Results
116 SDH patients (18 acute, 56 mixed acute/subacute/chronic, 42 subacute/chronic) were included. At 3 months, 61 (53 %) patients had good outcomes (mRS 0–3) while 55 (47 %) were severely disabled or dead (mRS 4–6). Of those who underwent surgical evacuation, 54/94 (57 %) had good outcomes compared to 7/22 (32 %) who did not (
p
= 0.030). Patients with mixed acuity or subacute/chronic SDH had significantly better 3-month mRS with surgery (median mRS 1 versus 5 without surgery,
p
= 0.002) compared to those with only acute SDH (
p
= 0.494). In multivariable analysis, premorbid mRS, age, admission Glasgow Coma Score, history of smoking, and fever were independent predictors of poor 3-month outcome (all
p
|
| doi_str_mv | 10.1007/s12028-016-0279-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1826687443</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2919553432</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-61c14c85587a76290ff7f2f554dcfa65685e0eae3ade2f61e9529c9b3c8489b03</originalsourceid><addsrcrecordid>eNp1kElLAzEYhoMoti4_wIsMePEymmWyeSuiVlAqqOeQZr5IS6epyUTovzelLiB4yva8b_gehE4IviAYy8tEKKaqxkTUmEpdkx00JJyXkxZkd7NvSC00YwN0kNIcbyDJ99GASsoKo4bo8SlCO3N9iKkKvrrNS9fPwtIuqknuXeigGvkeYvWcp22O5XoMne1DZ6-qUfUUQ1pBCXxA9dzndn2E9rxdJDj-Wg_R6-3Ny_W4fpjc3V-PHmrHJO1rQRxpnOJcSSsF1dh76annvGmdt4ILxQGDBWZboF4Q0Jxqp6fMqUbpKWaH6Hzbu4rhPUPqTTdLDhYLu4SQkyGKCqFk07CCnv1B5yHHMmAyVBPNOWsYLRTZUq6MlCJ4s4qzzsa1IdhsXJuta1Ncm41GQ0rm9Ks5TztofxLfcgtAt0AqT8s3iL9f_9_6CWTziEw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2919553432</pqid></control><display><type>article</type><title>Predictors of Functional Outcome After Subdural Hematoma: A Prospective Study</title><source>MEDLINE</source><source>SpringerLink Journals</source><source>ProQuest Central</source><creator>Weimer, Jonathan M. ; Gordon, Errol ; Frontera, Jennifer A.</creator><creatorcontrib>Weimer, Jonathan M. ; Gordon, Errol ; Frontera, Jennifer A.</creatorcontrib><description>Background
Although the incidence of subdural hematoma (SDH) has increased in the US in the last decade, limited prospective data exist examining risk factors for poor outcome.
Methods
A prospective, observational study of consecutive SDH patients was conducted from 7/2008 to 11/2011. Baseline clinical data, hospital and surgical course, complications, and imaging data were compared between those with good versus poor 3-month outcomes (modified Rankin Scores [mRS] 0–3 vs. 4–6). A multivariable logistic regression model was constructed to identify independent predictors of poor outcome.
Results
116 SDH patients (18 acute, 56 mixed acute/subacute/chronic, 42 subacute/chronic) were included. At 3 months, 61 (53 %) patients had good outcomes (mRS 0–3) while 55 (47 %) were severely disabled or dead (mRS 4–6). Of those who underwent surgical evacuation, 54/94 (57 %) had good outcomes compared to 7/22 (32 %) who did not (
p
= 0.030). Patients with mixed acuity or subacute/chronic SDH had significantly better 3-month mRS with surgery (median mRS 1 versus 5 without surgery,
p
= 0.002) compared to those with only acute SDH (
p
= 0.494). In multivariable analysis, premorbid mRS, age, admission Glasgow Coma Score, history of smoking, and fever were independent predictors of poor 3-month outcome (all
p
< 0.05; area under the curve 0.90), while SDH evacuation tended to improve outcomes (adjusted OR 3.90, 95 % CI 0.96–18.9,
p
= 0.057).
Conclusions
Nearly 50 % of SDH patients were dead or moderate-severely disabled at 3 months. Older age, poor baseline, poor admission neurological status, history of smoking, and fever during hospitalization predicted poor outcomes, while surgical evacuation was associated with improved outcomes among those with mixed acuity or chronic/subacute SDH.</description><identifier>ISSN: 1541-6933</identifier><identifier>EISSN: 1556-0961</identifier><identifier>DOI: 10.1007/s12028-016-0279-1</identifier><identifier>PMID: 27230968</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Activities of daily living ; Adult ; Aged ; Aged, 80 and over ; Coma ; Critical Care Medicine ; Female ; Follow-Up Studies ; Hematoma ; Hematoma, Subdural - mortality ; Hematoma, Subdural - therapy ; Hematoma, Subdural, Acute - mortality ; Hematoma, Subdural, Acute - therapy ; Hematoma, Subdural, Chronic - mortality ; Hematoma, Subdural, Chronic - therapy ; Hospitalization ; Hospitals ; Humans ; Intensive ; Internal Medicine ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Mortality ; Neurology ; Original Article ; Outcome Assessment (Health Care) - statistics & numerical data ; Patients ; Physiology ; Prognosis ; Prospective Studies ; Surgery ; Trauma ; Variables</subject><ispartof>Neurocritical care, 2017-02, Vol.26 (1), p.70-79</ispartof><rights>Springer Science+Business Media New York 2016</rights><rights>Springer Science+Business Media New York 2016.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-61c14c85587a76290ff7f2f554dcfa65685e0eae3ade2f61e9529c9b3c8489b03</citedby><cites>FETCH-LOGICAL-c372t-61c14c85587a76290ff7f2f554dcfa65685e0eae3ade2f61e9529c9b3c8489b03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12028-016-0279-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2919553432?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,776,780,21367,27901,27902,33721,33722,41464,42533,43781,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27230968$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Weimer, Jonathan M.</creatorcontrib><creatorcontrib>Gordon, Errol</creatorcontrib><creatorcontrib>Frontera, Jennifer A.</creatorcontrib><title>Predictors of Functional Outcome After Subdural Hematoma: A Prospective Study</title><title>Neurocritical care</title><addtitle>Neurocrit Care</addtitle><addtitle>Neurocrit Care</addtitle><description>Background
Although the incidence of subdural hematoma (SDH) has increased in the US in the last decade, limited prospective data exist examining risk factors for poor outcome.
Methods
A prospective, observational study of consecutive SDH patients was conducted from 7/2008 to 11/2011. Baseline clinical data, hospital and surgical course, complications, and imaging data were compared between those with good versus poor 3-month outcomes (modified Rankin Scores [mRS] 0–3 vs. 4–6). A multivariable logistic regression model was constructed to identify independent predictors of poor outcome.
Results
116 SDH patients (18 acute, 56 mixed acute/subacute/chronic, 42 subacute/chronic) were included. At 3 months, 61 (53 %) patients had good outcomes (mRS 0–3) while 55 (47 %) were severely disabled or dead (mRS 4–6). Of those who underwent surgical evacuation, 54/94 (57 %) had good outcomes compared to 7/22 (32 %) who did not (
p
= 0.030). Patients with mixed acuity or subacute/chronic SDH had significantly better 3-month mRS with surgery (median mRS 1 versus 5 without surgery,
p
= 0.002) compared to those with only acute SDH (
p
= 0.494). In multivariable analysis, premorbid mRS, age, admission Glasgow Coma Score, history of smoking, and fever were independent predictors of poor 3-month outcome (all
p
< 0.05; area under the curve 0.90), while SDH evacuation tended to improve outcomes (adjusted OR 3.90, 95 % CI 0.96–18.9,
p
= 0.057).
Conclusions
Nearly 50 % of SDH patients were dead or moderate-severely disabled at 3 months. Older age, poor baseline, poor admission neurological status, history of smoking, and fever during hospitalization predicted poor outcomes, while surgical evacuation was associated with improved outcomes among those with mixed acuity or chronic/subacute SDH.</description><subject>Activities of daily living</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Coma</subject><subject>Critical Care Medicine</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hematoma</subject><subject>Hematoma, Subdural - mortality</subject><subject>Hematoma, Subdural - therapy</subject><subject>Hematoma, Subdural, Acute - mortality</subject><subject>Hematoma, Subdural, Acute - therapy</subject><subject>Hematoma, Subdural, Chronic - mortality</subject><subject>Hematoma, Subdural, Chronic - therapy</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Intensive</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Neurology</subject><subject>Original Article</subject><subject>Outcome Assessment (Health Care) - statistics & numerical data</subject><subject>Patients</subject><subject>Physiology</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Surgery</subject><subject>Trauma</subject><subject>Variables</subject><issn>1541-6933</issn><issn>1556-0961</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kElLAzEYhoMoti4_wIsMePEymmWyeSuiVlAqqOeQZr5IS6epyUTovzelLiB4yva8b_gehE4IviAYy8tEKKaqxkTUmEpdkx00JJyXkxZkd7NvSC00YwN0kNIcbyDJ99GASsoKo4bo8SlCO3N9iKkKvrrNS9fPwtIuqknuXeigGvkeYvWcp22O5XoMne1DZ6-qUfUUQ1pBCXxA9dzndn2E9rxdJDj-Wg_R6-3Ny_W4fpjc3V-PHmrHJO1rQRxpnOJcSSsF1dh76annvGmdt4ILxQGDBWZboF4Q0Jxqp6fMqUbpKWaH6Hzbu4rhPUPqTTdLDhYLu4SQkyGKCqFk07CCnv1B5yHHMmAyVBPNOWsYLRTZUq6MlCJ4s4qzzsa1IdhsXJuta1Ncm41GQ0rm9Ks5TztofxLfcgtAt0AqT8s3iL9f_9_6CWTziEw</recordid><startdate>20170201</startdate><enddate>20170201</enddate><creator>Weimer, Jonathan M.</creator><creator>Gordon, Errol</creator><creator>Frontera, Jennifer A.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20170201</creationdate><title>Predictors of Functional Outcome After Subdural Hematoma: A Prospective Study</title><author>Weimer, Jonathan M. ; Gordon, Errol ; Frontera, Jennifer A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-61c14c85587a76290ff7f2f554dcfa65685e0eae3ade2f61e9529c9b3c8489b03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Activities of daily living</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Coma</topic><topic>Critical Care Medicine</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hematoma</topic><topic>Hematoma, Subdural - mortality</topic><topic>Hematoma, Subdural - therapy</topic><topic>Hematoma, Subdural, Acute - mortality</topic><topic>Hematoma, Subdural, Acute - therapy</topic><topic>Hematoma, Subdural, Chronic - mortality</topic><topic>Hematoma, Subdural, Chronic - therapy</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Intensive</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Neurology</topic><topic>Original Article</topic><topic>Outcome Assessment (Health Care) - statistics & numerical data</topic><topic>Patients</topic><topic>Physiology</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Surgery</topic><topic>Trauma</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Weimer, Jonathan M.</creatorcontrib><creatorcontrib>Gordon, Errol</creatorcontrib><creatorcontrib>Frontera, Jennifer A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Neurocritical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Weimer, Jonathan M.</au><au>Gordon, Errol</au><au>Frontera, Jennifer A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of Functional Outcome After Subdural Hematoma: A Prospective Study</atitle><jtitle>Neurocritical care</jtitle><stitle>Neurocrit Care</stitle><addtitle>Neurocrit Care</addtitle><date>2017-02-01</date><risdate>2017</risdate><volume>26</volume><issue>1</issue><spage>70</spage><epage>79</epage><pages>70-79</pages><issn>1541-6933</issn><eissn>1556-0961</eissn><abstract>Background
Although the incidence of subdural hematoma (SDH) has increased in the US in the last decade, limited prospective data exist examining risk factors for poor outcome.
Methods
A prospective, observational study of consecutive SDH patients was conducted from 7/2008 to 11/2011. Baseline clinical data, hospital and surgical course, complications, and imaging data were compared between those with good versus poor 3-month outcomes (modified Rankin Scores [mRS] 0–3 vs. 4–6). A multivariable logistic regression model was constructed to identify independent predictors of poor outcome.
Results
116 SDH patients (18 acute, 56 mixed acute/subacute/chronic, 42 subacute/chronic) were included. At 3 months, 61 (53 %) patients had good outcomes (mRS 0–3) while 55 (47 %) were severely disabled or dead (mRS 4–6). Of those who underwent surgical evacuation, 54/94 (57 %) had good outcomes compared to 7/22 (32 %) who did not (
p
= 0.030). Patients with mixed acuity or subacute/chronic SDH had significantly better 3-month mRS with surgery (median mRS 1 versus 5 without surgery,
p
= 0.002) compared to those with only acute SDH (
p
= 0.494). In multivariable analysis, premorbid mRS, age, admission Glasgow Coma Score, history of smoking, and fever were independent predictors of poor 3-month outcome (all
p
< 0.05; area under the curve 0.90), while SDH evacuation tended to improve outcomes (adjusted OR 3.90, 95 % CI 0.96–18.9,
p
= 0.057).
Conclusions
Nearly 50 % of SDH patients were dead or moderate-severely disabled at 3 months. Older age, poor baseline, poor admission neurological status, history of smoking, and fever during hospitalization predicted poor outcomes, while surgical evacuation was associated with improved outcomes among those with mixed acuity or chronic/subacute SDH.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>27230968</pmid><doi>10.1007/s12028-016-0279-1</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Activities of daily living Adult Aged Aged, 80 and over Coma Critical Care Medicine Female Follow-Up Studies Hematoma Hematoma, Subdural - mortality Hematoma, Subdural - therapy Hematoma, Subdural, Acute - mortality Hematoma, Subdural, Acute - therapy Hematoma, Subdural, Chronic - mortality Hematoma, Subdural, Chronic - therapy Hospitalization Hospitals Humans Intensive Internal Medicine Male Medicine Medicine & Public Health Middle Aged Mortality Neurology Original Article Outcome Assessment (Health Care) - statistics & numerical data Patients Physiology Prognosis Prospective Studies Surgery Trauma Variables |
| title | Predictors of Functional Outcome After Subdural Hematoma: A Prospective Study |
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