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Multicenter Study
. 2022 Jan:157:e179-e187.
doi: 10.1016/j.wneu.2021.09.121. Epub 2021 Oct 7.

Predictors of Mortality, Withdrawal of Life-Sustaining Measures, and Discharge Disposition in Octogenarians with Subdural Hematomas

Ahmed Kashkoush  1 , Jordan C Petitt  2 , Husayn Ladhani  2 , Vanessa P Ho  3 , Michael L Kelly  4 ; American Association for the Surgery of Trauma GERI-TBI Study Group
Collaborators, Affiliations
Multicenter Study

Predictors of Mortality, Withdrawal of Life-Sustaining Measures, and Discharge Disposition in Octogenarians with Subdural Hematomas

Ahmed Kashkoush et al. World Neurosurg. 2022 Jan.

Abstract

Objective: Risk factors for mortality in patients with subdural hematoma (SDH) include poor Glasgow Coma Scale (GCS) score, pupil nonreactivity, and hemodynamic instability on presentation. Little is published regarding prognosticators of SDH in the elderly. This study aims to examine risk factors for hospital mortality and withdrawal of life-sustaining measures in an octogenarian population presenting with SDH.

Methods: A prospectively collected multicenter database of 3279 traumatic brain injury admissions to 45 different U.S. trauma centers between 2017 and 2019 was queried to identify patients aged >79 years old presenting with SDH. Factors collected included baseline demographic data, past medical history, antiplatelet/anticoagulant use, and clinical presentation (GCS, pupil reactivity, injury severity scale [ISS]). Primary outcome data included hospital mortality/discharge to hospice care and withdrawal of life-sustaining measures. Multivariate logistic regression analyses were used to identify factors independently associated with primary outcome variables.

Results: A total of 695 patients were isolated for analysis. Of the total cohort, the rate of hospital mortality or discharge to hospice care was 22% (n = 150) and the rate of withdrawal of life-sustaining measures was 10% (n = 66). A multivariate logistic regression model identified GCS <13, pupil nonreactivity, increasing ISS, intraventricular hemorrhage, and neurosurgical intervention as factors independently associated with hospital mortality/hospice. Congestive heart failure (CHF), hypotension, GCS <13, and neurosurgical intervention were independently associated with withdrawal of life-sustaining measures.

Conclusions: Poor GCS, pupil nonreactivity, ISS, and intraventricular hemorrhage are independently associated with hospital mortality or discharge to hospice care in patients >80 years with SDH. Pre-existing CHF may further predict withdrawal of life-sustaining measures.

Keywords: Mortality; Octogenarians; Subdural hematoma; Traumatic brain injury.

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Figures

Figure 1.
Figure 1.
ROC (receiver operating characteristic) curves with AUROC (area under ROC) for binary logistic regression models predicting (A) mortality/hospice and (B) withdrawal of life-sustaining measures
See this image and copyright information in PMC

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