Department of Neurological Sciences, Section of Neurocritical Care, Rush University Medical Center; and.
J Neurosurg. 2013 Nov;119(5):1296-301. doi: 10.3171/2013.4.JNS122236. Epub 2013 Jun 7.
Subdural hematoma (SDH) is a common diagnosis in neurosurgical and neurocritical practice. Comprehensive outcome data are lacking for nontraumatic SDH. The authors determined which factors are associated with in-hospital mortality in a large sample of patients with nontraumatic SDH.
Using the Nationwide Inpatient Sample, the authors selected adults who had been hospitalized in the US between 2007 and 2009 and in whom a primary diagnosis of nontraumatic SDH (ICD-9-CM code 432.1) had been made. Demographics, comorbidities, surgical treatment, and discharge outcomes were identified. Univariate and multivariate analyses were performed to identify predictors of in-hospital mortality.
Among 14,093 patients with acute nontraumatic SDH, the mean age was 71.4 ± 14.8 (mean ± standard deviation). In addition, 22.2% of the patients were admitted during the weekend. Surgical evacuation was performed in 51.4% of the patients, and 11.8% of all patients died during hospitalization. In multivariate analyses, patient age (adjusted OR 1.02, 95% CI 1.012-1.022), congestive heart failure (adjusted OR 1.42, 95% CI 1.19-1.71), warfarin use (adjusted OR 1.41, 95% CI 1.17-1.70), coagulopathy (adjusted OR 2.14, 95% CI 1.75-2.61), mechanical ventilation (adjusted OR 16.85, 95% CI 14.29-19.86), and weekend admission (adjusted OR 1.19, 95% CI 1.02-1.38) were independent predictors of in-hospital mortality. Race (Hispanic: adjusted OR 0.65, 95% CI 0.51-0.83; black: adjusted OR 0.78, 95% CI 0.63-0.96), urban hospital location (adjusted OR 0.69, 95% CI 0.54-0.89), and surgical SDH evacuation (adjusted OR 0.52, 95% CI 0.45-0.60) were strong independent predictors for decreased mortality.
One in 9 patients with nontraumatic SDH dies during hospitalization. Among the several predictors of in-hospital mortality, the weekend effect and treatment with surgical evacuation are potentially modifiable factors. Further investigation may lead to improvements in management and outcomes.
硬脑膜下血肿（SDH）是神经外科和神经危重症实践中的常见诊断。非创伤性 SDH 的综合预后数据尚缺乏。作者旨在确定在大量非创伤性 SDH 患者中哪些因素与住院期间死亡率相关。
作者利用全美住院患者样本，选择了 2007 年至 2009 年期间在美国住院治疗且原发性诊断为非创伤性 SDH（ICD-9-CM 编码 432.1）的成年人。确定了人口统计学、合并症、手术治疗和出院结局。进行了单变量和多变量分析，以确定住院期间死亡率的预测因素。
在 14093 例急性非创伤性 SDH 患者中，平均年龄为 71.4±14.8（平均值±标准差）。此外，22.2%的患者在周末入院。51.4%的患者接受了手术清除，11.8%的患者在住院期间死亡。多变量分析显示，患者年龄（校正比值比 1.02，95%置信区间 1.012-1.022）、充血性心力衰竭（校正比值比 1.42，95%置信区间 1.19-1.71）、华法林使用（校正比值比 1.41，95%置信区间 1.17-1.70）、凝血障碍（校正比值比 2.14，95%置信区间 1.75-2.61）、机械通气（校正比值比 16.85，95%置信区间 14.29-19.86）和周末入院（校正比值比 1.19，95%置信区间 1.02-1.38）是住院期间死亡率的独立预测因素。种族（西班牙裔：校正比值比 0.65，95%置信区间 0.51-0.83；黑人：校正比值比 0.78，95%置信区间 0.63-0.96）、城市医院位置（校正比值比 0.69，95%置信区间 0.54-0.89）和手术 SDH 清除（校正比值比 0.52，95%置信区间 0.45-0.60）是死亡率降低的强独立预测因素。
每 9 例非创伤性 SDH 患者中就有 1 例在住院期间死亡。在住院期间死亡率的几个预测因素中，周末效应和手术清除治疗是潜在可改变的因素。进一步的研究可能会改善管理和预后。
