Trevisi Gianluca, Scerrati Alba, Rustemi Oriela, Ricciardi Luca, Ius Tamara, Auricchio Anna Maria, De Bonis Pasquale, Albanese Alessio, Mangiola Annunziato, Maugeri Rosario, Nicolosi Federico, Sturiale Carmelo Lucio
Neurosurgical Unit, Ospedale Santo Spirito, Via Fonte Romana, 8, 65124 Pescara, Italy.
Department of Neurosciences, Imaging and Clinical Sciences, G. D'Annunzio University, Via dei Vestini 31, 66100 Chieti, Italy.
J Pers Med. 2022 Sep 30;12(10):1612. doi: 10.3390/jpm12101612.
The incidence of traumatic acute subdural hematomas (ASDH) in the elderly is increasing. Despite surgical evacuation, these patients have poor survival and low rate of functional outcome, and surgical timing plays no clear role as a predictor. We investigated whether the timing of surgery had a major role in influencing the outcome in these patients.
We retrospectively retrieved clinical and radiological data of all patients ≥70 years operated on for post-traumatic ASDH in a 3 year period in five Italian hospitals. Patients were divided into three surgical timing groups from hospital arrival: (within 6 h); (6-24 h); and (after 24 h). Outcome was measured at discharge using two endpoints: survival (alive/dead) and functional outcome at the Glasgow Outcome Scale (GOS). Univariate and multivariate predictor models were constructed.
We included 136 patients. About 33% died as a result of the consequences of ASDH and among the survivors, only 24% were in good functional outcome at discharge. Surgical timing groups appeared different according to presenting the Glasgow Outcome Scale (GCS), which was on average lower in the group, and radiological findings, which appeared worse in the same group. Delayed surgery was more frequent in patients with subacute clinical deterioration. Surgical timing appeared to be neither associated with survival nor with functional outcome, also after stratification for preoperative GCS. Preoperative midline shift was the strongest outcome predictor.
An earlier surgery was offered to patients with worse clinical-radiological findings. Additionally, after stratification for GCS, it was not associated with better outcome. Among the radiological markers, preoperative midline shift was the strongest outcome predictor.
老年创伤性急性硬膜下血肿（ASDH）的发病率正在上升。尽管进行了手术清除血肿，但这些患者的生存率较低且功能预后率低，手术时机作为预测指标的作用尚不明确。我们研究了手术时机在影响这些患者预后方面是否起主要作用。
我们回顾性检索了意大利五家医院在3年期间对所有年龄≥70岁的创伤后ASDH患者进行手术的临床和放射学数据。从入院时间起，将患者分为三个手术时机组：（6小时内）；（6 - 24小时）；以及（24小时后）。出院时使用两个终点指标衡量预后：生存情况（存活/死亡）和格拉斯哥预后量表（GOS）的功能预后。构建了单变量和多变量预测模型。
我们纳入了136例患者。约33%的患者因ASDH的后果死亡，在幸存者中，只有24%在出院时功能预后良好。根据格拉斯哥昏迷量表（GCS），手术时机组有所不同，平均而言，组中的GCS较低，并且放射学检查结果在同一组中似乎更差。亚急性临床恶化的患者延迟手术更为常见。手术时机似乎与生存率和功能预后均无关，术前GCS分层后也是如此。术前中线移位是最强的预后预测指标。
临床放射学检查结果较差的患者接受了更早的手术。此外，在GCS分层后，手术时机与更好的预后无关。在放射学标志物中，术前中线移位是最强的预后预测指标。
