The Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.
Department of Neurosurgery, Tampere University Hospital, Tampere, Finland.
Acta Neurochir (Wien). 2024 Mar 22;166(1):144. doi: 10.1007/s00701-024-06040-y.
The objective was to determine the incidence of surgically treated chronic subdural hematoma (cSDH) within six months after head trauma in a consecutive series of head injury patients with a normal initial computed tomography (CT).
A total of 1941 adult patients with head injuries who underwent head CT within 48 h after injury and were treated at the Tampere University Hospital's emergency department were retrospectively evaluated from medical records (median age = 59 years, IQR = 39-79 years, males = 58%, patients using antithrombotic medication = 26%). Patients with no signs of acute traumatic intracranial pathology or any type of subdural collection on initial head CT were regarded as CT negative (n = 1573, 81%).
Two (n = 2) of the 1573 CT negative patients received surgical treatment for cSDH. Consequently, the incidence of surgically treated cSDH after a normal initial head CT during a six-month follow-up was 0.13%. Both patients sustained mild traumatic brain injuries initially. One of the two patients was on antithrombotic medication (warfarin) at the time of trauma, hence incidence of surgically treated cSDH among patients with antithrombotic medication in CT negative patients (n = 376, 23.9%) was 0.27%. Additionally, within CT negative patients, one subdural hygroma was operated shortly after trauma.
The extremely low incidence of surgically treated cSDH after a normal initial head CT, even in patients on antithrombotic medication, supports the notion that routine follow-up imaging after an initial normal head CT is not indicated to exclude the development of cSDH. Additionally, our findings support the concept of cSDH not being a purely head trauma-related disease.
旨在确定在初始计算机断层扫描（CT）正常的颅脑损伤患者中，颅脑损伤后 6 个月内接受慢性硬膜下血肿（cSDH）手术治疗的发生率。
回顾性评估了来自医疗记录的 1941 名成年颅脑损伤患者，这些患者在受伤后 48 小时内行头部 CT，在坦佩雷大学医院急诊部接受治疗（中位数年龄=59 岁，IQR=39-79 岁，男性=58%，使用抗血栓药物的患者=26%）。最初头部 CT 无急性创伤性颅内病理或任何类型硬膜下积液的患者被视为 CT 阴性（n=1573，81%）。
在 1573 例 CT 阴性患者中，有 2 例（n=2）接受了 cSDH 的手术治疗。因此，在 6 个月的随访期间，初始正常头部 CT 后接受手术治疗的 cSDH 的发生率为 0.13%。这两名患者最初都有轻度创伤性脑损伤。其中一名患者在创伤时正在服用抗血栓药物（华法林），因此在 CT 阴性患者（n=376，23.9%）中，使用抗血栓药物的患者中 cSDH 的手术治疗发生率为 0.27%。此外，在 CT 阴性患者中，1 例硬膜下水肿在创伤后不久就进行了手术。
即使在服用抗血栓药物的患者中，初始正常头部 CT 后 cSDH 经手术治疗的发生率极低，这支持了初始正常头部 CT 后无需常规进行影像学随访以排除 cSDH 发展的观点。此外，我们的研究结果支持 cSDH 并非单纯与头部创伤相关的疾病的概念。
