Chronic subdural hematoma: a sentinel health event

Abstract

Objective: To propose that chronic subdural hematoma (CSDH) should be conceived as a sentinel event in elderly patients and offer an analysis of long-term survival after diagnosis.

Methods: A retrospective review of 301 consecutive patients ≥55 years old admitted to an academic medical center with a primary diagnosis of CSDH between January 1996 and January 2010 was performed. The effects of advanced age and surgical intervention on survival were independently assessed. These groups were compared with standardized mortality ratios (SMRs) on the basis of patient age at time of presentation.

Results: Mortality after diagnosis of CSDH increases with increased age at presentation. For all patients, the median survival was roughly 4 years after diagnosis (4.0 years ± 0.5). Median survival is decreased with older age at presentation, to a nadir of 1.5 years ± 0.6 for patients ≥85 years old (P = 0.0003, log-rank test). Compared with the reference data from the U.S. Centers of Disease Control and Prevention, 1-year SMR was increased in all age groups. An asymmetric increase in SMR was seen between age groups, with the greatest effect on the youngest subpopulation (SMR 2.9).

Conclusions: The increased mortality rates in patients with CSDHs relative to standardized mortality data corroborate the conception of subdural hematoma as a sentinel health event.

Keywords: Actuarial survival; CDC; CSDH; Chronic subdural hematoma; Elderly; Kaplan-Meier; Mortality; Outcome; SDH; SMR; Standardized mortality ratio; Subdural hematoma; U.S. Centers for Disease Control and Prevention.