Rozzelle C J, Wofford J L, Branch C L
Department of Internal Medicine, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC 27103.
J Am Geriatr Soc. 1995 Mar;43(3):240-4. doi: 10.1111/j.1532-5415.1995.tb07329.x.
To identify presenting characteristics of older patients with subdural hematoma who are unlikely to survive hospitalization.
A retrospective cohort.
All patients > or = 65 years of age hospitalized at a tertiary care center from 1985-1990 with the primary diagnosis of subdural hematoma.
Chart review was performed to characterize presenting clinical characteristics, hospital course, and outcome at the time of hospital discharge.
Of the 157 eligible patients, 42% (66/157) were > or = 80 years of age. Although 30% of patients had no recorded trauma, 54% experienced a fall before hospitalization. Twenty-six percent (47/157) of patients had been on antithrombotic therapy (14 on coumadin, two on heparin, 31 on antiplatelet agents, one on both coumadin and an antiplatelet agent). Sixty percent of patients had no focal neurologic findings, and the mean Glasgow Coma Score was 12.3 (+/- 3.6). The hematoma was considered chronic in 49% (77/157) of cases, based on time from antecedent trauma or on neuroimaging criteria. Midline shift by neuroimaging was present in 69%. Overall hospital mortality was 31% (48/157). Using logistic regression to control for other factors, level of consciousness (Glasgow Coma Score < = 7) (OR = 10.4), age > or = 80 (OR = 3.7), duration of hematoma considered acute (OR = 2.7), and craniotomy (OR = 2.6) were significantly associated with hospital mortality. Presence of focal symptoms, previous antithrombotic medication use, nature of trauma, comorbidity score, and presence of midline shift were not associated with hospital mortality.
Among older patients with subdural hematoma, level of consciousness, extreme old age, duration of the hematoma, and nature of the intervention were significantly associated with hospital mortality. These factors should help physicians in clinical decision making and formulation of advance directives for geriatric patients with subdural hematoma.
确定不太可能存活至出院的老年硬膜下血肿患者的呈现特征。
一项回顾性队列研究。
1985年至1990年在一家三级护理中心住院的所有年龄≥65岁且初步诊断为硬膜下血肿的患者。
进行病历审查以描述呈现的临床特征、住院过程及出院时的结局。
在157例符合条件的患者中，42%（66/157）年龄≥80岁。虽然30%的患者没有记录到外伤，但54%的患者在住院前有跌倒史。26%（47/157）的患者接受过抗血栓治疗（14例使用华法林，2例使用肝素，31例使用抗血小板药物，1例同时使用华法林和抗血小板药物）。60%的患者没有局灶性神经系统体征，格拉斯哥昏迷评分平均为12.3（±3.6）。根据距先前外伤的时间或神经影像学标准，49%（77/157）的病例血肿被认为是慢性的。神经影像学显示中线移位的占69%。总体医院死亡率为31%（48/157）。使用逻辑回归控制其他因素后，意识水平（格拉斯哥昏迷评分≤7）（比值比=10.4）、年龄≥80岁（比值比=3.7）、血肿被认为是急性的持续时间（比值比=2.7）以及开颅手术（比值比=2.6）与医院死亡率显著相关。局灶性症状的存在、先前使用抗血栓药物、外伤性质、合并症评分以及中线移位的存在与医院死亡率无关。
在老年硬膜下血肿患者中，意识水平、高龄、血肿持续时间和干预性质与医院死亡率显著相关。这些因素应有助于医生为老年硬膜下血肿患者进行临床决策和制定预先指示。
