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. 2022 Oct;164(10):2719-2730.
doi: 10.1007/s00701-022-05216-8. Epub 2022 May 3.

External validation of prognostic models predicting outcome after chronic subdural hematoma

Dana C Holl  1   2   3 , Ana Mikolic  4 , Jurre Blaauw  5 , Roger Lodewijkx  6 , Merijn Foppen  6 , Korné Jellema  7 , Niels A van der Gaag  8 , Heleen M den Hertog  9 , Bram Jacobs  5 , Joukje van der Naalt  5 , Dagmar Verbaan  6 , K H Kho  10   11 , C M F Dirven  12 , Ruben Dammers  12 , Hester F Lingsma  4 , David van Klaveren  4
Affiliations

External validation of prognostic models predicting outcome after chronic subdural hematoma

Dana C Holl et al. Acta Neurochir (Wien). 2022 Oct.

Abstract

Background: Several prognostic models for outcomes after chronic subdural hematoma (CSDH) treatment have been published in recent years. However, these models are not sufficiently validated for use in daily clinical practice. We aimed to assess the performance of existing prediction models for outcomes in patients diagnosed with CSDH.

Methods: We systematically searched relevant literature databases up to February 2021 to identify prognostic models for outcome prediction in patients diagnosed with CSDH. For the external validation of prognostic models, we used a retrospective database, containing data of 2384 patients from three Dutch regions. Prognostic models were included if they predicted either mortality, hematoma recurrence, functional outcome, or quality of life. Models were excluded when predictors were absent in our database or available for < 150 patients in our database. We assessed calibration, and discrimination (quantified by the concordance index C) of the included prognostic models in our retrospective database.

Results: We identified 1680 original publications of which 1656 were excluded based on title or abstract, mostly because they did not concern CSDH or did not define a prognostic model. Out of 18 identified models, three could be externally validated in our retrospective database: a model for 30-day mortality in 1656 patients, a model for 2 months, and another for 3-month hematoma recurrence both in 1733 patients. The models overestimated the proportion of patients with these outcomes by 11% (15% predicted vs. 4% observed), 1% (10% vs. 9%), and 2% (11% vs. 9%), respectively. Their discriminative ability was poor to modest (C of 0.70 [0.63-0.77]; 0.46 [0.35-0.56]; 0.59 [0.51-0.66], respectively).

Conclusions: None of the examined models showed good predictive performance for outcomes after CSDH treatment in our dataset. This study confirms the difficulty in predicting outcomes after CSDH and emphasizes the heterogeneity of CSDH patients. The importance of developing high-quality models by using unified predictors and relevant outcome measures and appropriate modeling strategies is warranted.

Keywords: Chronic subdural hematoma; External validation; Mortality; Prognostic models; Recurrence.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the article selection process
Fig. 2
Fig. 2
Performance of models in the retrospective database. a Alford. b Jack. c Andersen
See this image and copyright information in PMC

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