Manivannan Susruta, Spencer Robert, Marei Omar, Mayo Isaac, Elalfy Omar, Martin John, Zaben Malik
Department of Neurosurgery, Southampton University Hospitals NHS Trust, Southampton, UK.
Department of Neurosurgery, Queen Elizabeth University Hospital, Glasgow, UK.
BMJ Open. 2021 Dec 3;11(12):e050786. doi: 10.1136/bmjopen-2021-050786.
Acute subdural haematoma (ASDH) is a devastating pathology commonly found on CT brain scans of patients with traumatic brain injury. The role of surgical intervention in the elderly has been increasingly questioned due to its associated morbidity and mortality. Therefore, a systematic review and meta-analysis of the literature to quantify the mortality and functional outcomes associated with surgical management of ASDH in the elderly was performed.
DESIGN/SETTING: A multidatabase literature search between January 1990 and May 2020, and meta-analysis of proportions was performed to quantify mortality and unfavourable outcome (Glasgow Outcome scale 1-3; death/ severe disability) rates.
Studies reporting patients aged 60 years or older.
Craniotomy, decompressive craniectomy, conservative management.
Mortality and functional outcomes (discharge, long-term follow-up (LTFU)).
2572 articles were screened, yielding 21 studies for final inclusion and 15 for meta-analysis. Pooled estimates of mortality were 39.83% (95% CI 32.73% to 47.14%; 10 studies, 308/739 patients, I=73%) at discharge and 49.30% (95% CI 42.01% to 56.61%; 10 studies, 277/555 patients, I=63%) at LTFU. Mean duration of follow-up was 7.1 months (range 2-12 months). Pooled estimate of percentage of poor outcomes was 81.18% (95% CI 75.61% to 86.21%; 6 studies, 363/451 patients, I=45%) at discharge, and 79.25% (95% CI 72.42% to 85.37%; 8 studies, 402/511 patients, I=66%) at LTFU. Mean duration of follow-up was 6.4 months (range 2-12 months). Potential risk factors for poor outcome included age, baseline functional status, preoperative neurological status and imaging parameters.
Outcomes following surgical evacuation of ASDH in patients aged 60 years and above are poor. This constitutes the best level of evidence in the current literature that surgical intervention for ASDH in the elderly carries significant risks, which must be weighed against benefits.
CRD42020189508.
急性硬膜下血肿（ASDH）是一种常见于创伤性脑损伤患者脑部CT扫描的严重病变。由于其相关的发病率和死亡率，手术干预在老年人中的作用越来越受到质疑。因此，我们对文献进行了系统回顾和荟萃分析，以量化老年患者ASDH手术治疗相关的死亡率和功能结局。
设计/背景：对1990年1月至2020年5月期间进行多数据库文献检索，并对比例进行荟萃分析，以量化死亡率和不良结局（格拉斯哥结局量表1 - 3级；死亡/严重残疾）发生率。
报告60岁及以上患者的研究。
开颅手术、减压性颅骨切除术、保守治疗。
死亡率和功能结局（出院时、长期随访（LTFU））。
筛选了2572篇文章，最终纳入21项研究，15项用于荟萃分析。出院时合并死亡率估计为39.83%（95%CI 32.73%至47.14%；10项研究，308/739例患者，I = 73%），长期随访时为49.30%（95%CI 42.01%至56.61%；10项研究，277/555例患者，I = 63%）。平均随访时间为7.1个月（范围2 - 12个月）。出院时不良结局百分比的合并估计为81.18%（95%CI 75.61%至86.21%；6项研究，363/451例患者，I = 45%），长期随访时为79.25%（95%CI 72.42%至85.37%；8项研究，402/511例患者，I = 66%）。平均随访时间为6.4个月（范围2 - 12个月）。不良结局的潜在风险因素包括年龄、基线功能状态、术前神经状态和影像学参数。
60岁及以上患者ASDH手术清除后的结局较差。这是当前文献中关于老年患者ASDH手术干预存在重大风险的最佳证据水平，必须权衡其益处与风险。
PROSPERO注册号：CRD42020189508。
