Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov;165(11):3229-3238.
doi: 10.1007/s00701-023-05737-w. Epub 2023 Aug 30.

Modified Puerto Rico Recurrence Scale for chronic subdural hematomas: augmenting the grading scale with postoperative pneumocephalus volume

Giancarlo Mignucci-Jiménez  1   2 , Alejandro J Matos-Cruz  1   3 , Grant Koskay  2 , Sahin Hanalioglu  2 , Nicolas I Gonzalez-Romo  2 , Yuan Xu  2 , Melissa S Kovacs  2 , Mark C Preul  4 , Caleb E Feliciano-Valls  1
Affiliations

Modified Puerto Rico Recurrence Scale for chronic subdural hematomas: augmenting the grading scale with postoperative pneumocephalus volume

Giancarlo Mignucci-Jiménez et al. Acta Neurochir (Wien). 2023 Nov.

Abstract

Background: Chronic subdural hematomas (CSDHs) are common in the elderly, with a relatively high rate of recurrence after initial surgical intervention. Our research team previously created a predictive grading system, the Puerto Rico Recurrence Scale (PRRS), to identify patients at high risk of CSDH recurrence. In this study, we introduce a modification of the (mPRRS) that includes pneumocephalus volume, which has been independently associated with recurrence.

Methods: A single-center Puerto Rican population-based retrospective study was performed to analyze data for patients treated for CSDH at 1 institution between July 1, 2017, and December 31, 2019. Univariate and multivariate analyses were used to create a grading scale predictive of recurrence. Retrospective validation was conducted for the cohort.

Results: Of 108 patients included in the study, 42 had recurrence, and 66 had nonrecurrence. Postoperative subdural space, postoperative midline shift, and pneumocephalus volume were all higher with recurrence (P = 0.002, P = 0.009, and P < 0.001, respectively). Multivariate analysis was used to create a 6-point grading scale comprising 3 variables (pneumocephalus volume [< 10, 10-20, 21-30, and > 30 cm3], postoperative midline shift [< 0.4, 0.41-1.0, and > 1.0 cm], and laterality [unilateral and bilateral]). Recurrence rates progressively increased in low-risk to high-risk groups (2/18 [11%] vs 21/34 [62%]; P < 0.003).

Conclusion: The mPRRS incorporating pneumocephalus measurement improves CSDH recurrence prediction. The mPRRS indicated that patients with higher scores have a greater risk of recurrence and emphasized the importance of measuring postoperative variables for prediction. The mPRRS grading scale for CSDHs may be applicable not only to the Puerto Rican population but also to the general population.

Keywords: Chronic subdural hematoma; Grading scale; Pneumocephalus; Puerto Rico; Recurrence.

PubMed Disclaimer

References

    1. Amoo M, O’Cearbhaill RM, McHugh P, Henry J, O’Byrne K, Ben Husien M, Javadpour M (2021) Derivation of a clinical score for prediction of recurrence following evacuation of chronic subdural hematoma: a retrospective cohort study at a National Referral Centre. World Neurosurg 154:e743–e753 - DOI - PubMed
    1. Andersen-Ranberg NC, Debrabant B, Poulsen FR, Bergholt B, Hundsholt T, Fugleholm K (2019) The Danish chronic subdural hematoma study-predicting recurrence of chronic subdural hematoma. Acta Neurochir (Wien) 161:885–894 - DOI - PubMed
    1. US Census Bureau (2020) U.S. Census Bureau, 2016–2020 American Community Survey 5-year estimates. https://data.census.gov
    1. Caetano R, Gruenewald P, Vaeth PAC, Canino G (2018) DSM-5 Alcohol use disorder severity in Puerto Rico: prevalence, criteria profile, and correlates. Alcohol Clin Exp Res 42:378–386 - DOI - PubMed - PMC
    1. Clayton P (2013) CUTPT: Stata module for empirical estimation of cutpoint for a diagnostic test. Statistical Software Components. https://ideas.repec.org/c/boc/bocode/s457719.html

Publication types

LinkOut - more resources