Risk Factors Contributing to Higher Mortality Rates in Elderly Patients with Acute Traumatic Subdural Hematoma Sustained in a Fall: A Cross-Sectional Analysis Using Registered Trauma Data

Background: We aimed to explore the risk factors that contribute to the mortality of elderly trauma patients with acute subdural hematoma (SDH) resulting from a fall. Mortality rates of the elderly were compared to those of young adults. Methods: A total of 444 patients with acute traumatic subdural hematoma resulting from a fall, admitted to a level I trauma center from 1 January 2009 to 31 December 2016 were enrolled in this study. Patients were categorized into two groups: elderly patients (n = 279) and young adults (n = 165). The primary outcome of this study was patient mortality in hospital. The adjusted odds ratio (AOR) with 95% confidence interval (CI) for mortality was calculated according to gender and pre-existing comorbidities. Univariate and multivariate logistic regression analyses were performed to identify factors related to mortality in the elderly. Results: The odds ratio for mortality caused by falls in the elderly patients was four-fold higher than in the young adults, after adjusting for gender and pre-existing comorbidities. In addition, the presence of pre-existing coronary artery disease (OR 3.2, 95% CI 1.09–9.69, p = 0.035), end-stage renal disease (OR 4.6, 95% CI 1.48–14.13, p = 0.008), hematoma volume (OR 1.2, 95% CI 1.11–1.36, p < 0.001), injury severity score (OR 1.3, 95% CI 1.23–1.46, p < 0.001), and coagulopathy (OR 4.0, 95% CI 1.47–11.05, p = 0.007) were significant independent risk factors for mortality in patients with acute traumatic SDH resulting from a fall. Conclusions: In this study, we identified that pre-existing CAD, ESRD, hematoma volume, ISS, and coagulopathy were significant independent risk factors for mortality in patients with acute traumatic SDH. These results suggest that death following acute SDH is influenced both by the extent of neurological damage and the overall health of the patient at the time of injury.

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Factors Favoring the Development of Chronic Subdural Hematoma After Traumatic Acute Subdural Hematoma in the Elderly

The American Surgeon ◽

10.1177/00031348211056279 ◽

2021 ◽

pp. 000313482110562

Author(s):

Tarik Wasfie ◽

Nicholas Fitzpatrick ◽

Mursal Niasan ◽

Jennifer L. Hille ◽

Raquel Yapchai ◽

...

Keyword(s):

Risk Factors ◽

Elderly Patients ◽

Anticoagulant Therapy ◽

Subdural Hematoma ◽

Significant Risk ◽

Chronic Subdural Hematoma ◽

The Elderly ◽

Acute Subdural Hematoma ◽

Mortality Data ◽

Group A

Introduction Traumatic acute subdural hematoma (TASDH) is by far the most common traumatic brain injury in elderly patients presented to the emergency department, and a number of those treated conservatively will develop chronic subdural hematoma (CSDH). The factors contributing to chronicity were not well studied in the elderly; therefore, we retrospectively analyzed our elderly patients with acute subdural hematomas to identify the risk factors which might contribute to the development of subsequent CSDH. Methods A retrospective analysis of 254 patients with TASDH admitted between 2012 and 2016 to our level 2 trauma department in a community hospital was collected. Data include age, sex, comorbid conditions, CT findings, anticoagulant therapy, surgical interventions, disposition after discharge, and mortality. Data on those readmitted within the first 2 months with the diagnosis of CSDH were also studied (group A), and compared to those not readmitted (group B). Multiple logistic regression was used to determine the risk factors associated with readmission at P ≤ .05. Institutional review board approval was obtained for this study. Results There were 254 patients who were admitted with TASDH, 144 male (56.7%) and 110 female (43.3%), with the mean age of 71.4 (SD ± 19.38) years. Only 37 patients (14.6%) went for surgery in their initial admission. A total of 14 patients (5.6%) were readmitted subsequently with the diagnosis of CSDH within two months of initial discharge (group A). Only four patients (28.5%) were on anticoagulant therapy and these patients went for emergency craniotomy for evacuation of hematoma. All 14 patients had a history of coronary artery disease and hypertension and only 5 (35.7%) were diabetic. Review of head CT on initial admission of those patients revealed 4 patients (28.5%) had multiple lesions and 4 (28.5%) had tentorial/falax bleeding and 4 (28.5%) had a shift. The initial size and thickness of the bleeding was 1.4-5 mm. The adjusted model identified diabetes, race, and initial disposition as significant risk factors ( P < .05). Conclusion Risk associated with the transformation of TASDH to CSDH is difficult to assess in those group of elderly patients because of the small number; however, diabetes, race, and initial disposition to home pointed toward a risk for future development of CSDH and those patients should be followed clinically and radiographically over the next few months after discharge, particularly those on anticoagulant therapy.

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Frequency of and Risk Factors for Chronification in Traumatic Acute Subdural Hematoma following Conservative Therapy

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0039-1685188 ◽

2019 ◽

Vol 80 (05) ◽

pp. 359-364 ◽

Cited By ~ 2

Author(s):

Stefanie Kaestner ◽

Marina van den Boom ◽

Wolfgang Deinsberger

Keyword(s):

Risk Factors ◽

Subdural Hematoma ◽

Head Injuries ◽

Chronic Subdural Hematoma ◽

Length Of Hospital Stay ◽

The Elderly ◽

Coagulation System ◽

Acute Subdural Hematoma ◽

Neurosurgical Department ◽

Anticoagulant Medication

Background In an aging society, traumatic head injuries, such as acute subdural hematomas (aSDHs), are increasingly common because the elderly are prone to falls and are often undergoing anticoagulation treatment. Especially in advanced age, cranial surgery such as craniotomies may put patients in further jeopardy. But if treatment is conservative, a chronic subdural hematoma (cSDH) may develop, requiring surgical evacuation. Existing studies have reported a correlation between several risk factors contributing to the frequency of chronification. To improve the prediction of the course of disease and to aid counseling patients and relatives, this study aimed to determine the frequency and the main risk factors influencing the process of chronification of an aSDH following conservative treatment. Methods We identified patients presenting between January 2012 and September 2017 at our neurosurgical department with an aSDH. All patients treated conservatively were selected retrospectively, and the following parameters were documented: age, sex, chronification status, Glasgow Coma Scale score on admission and discharge, hematoma thickness and density, the degree of midline shift (MLS), prior anticoagulants and administration of procoagulants, thrombosis management, other coagulopathies, initial length of hospital stay, interval between discharge and readmission, and interval between initial injury and date of surgery and last follow-up. The cohort was divided into patients with complete resolution of their aSDH, and patients who needed surgery due to chronification. Results A total of 75 conservatively treated patients with aSDH were included. A chronification was observed in 24 cases (32%). The process of chronification takes an average of 18 days (range: 10–98 days). The following factors were significantly associated with the process of chronification: age (p = 0.001), anticoagulant medication (acetylsalicylic acid [ASA], Coumadin, and novel anticoagulants [NOACs]) before injury (p = 0.026), administration of procoagulants (p = 0.001), presence of other coagulopathies such as thrombocytopenia (p = 0.002), low hematoma density at discharge (p = 0.001), hematoma thickness on admission and discharge (p = 0.001), and the degree of MLS (p = 0.044). Conclusion Chronification occurred in a third of all patients with conservatively treated aSDH, on average within 3 weeks. The probability of developing a cSDH is 0.96 times higher with every yearly increase in age, resulting in 56% chronification in patients ≥ 70 years. Hematoma thickness and impairment of the coagulation system such as anticoagulant medication (ASA, Coumadin, and NOACs) or thrombocytopenia are further risk factors for chronification.

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Endoscopic Hematoma Evacuation for Acute Subdural Hematoma in the Elderly: A Preliminary Study

Surgical Innovation ◽

10.1177/1553350618785270 ◽

2018 ◽

Vol 25 (5) ◽

pp. 455-464 ◽

Cited By ~ 2

Author(s):

Hiroaki Matsumoto ◽

Hiroaki Minami ◽

Hiroaki Hanayama ◽

Yasuhisa Yoshida

Keyword(s):

Elderly Patients ◽

Endoscopic Surgery ◽

Subdural Hematoma ◽

Hospital Costs ◽

The Elderly ◽

Acute Subdural Hematoma ◽

Simple Type ◽

Endoscopic Surgical Procedures ◽

Hematoma Evacuation ◽

Operative Indications

Aim. Endoscopic surgery for acute subdural hematoma (ASDH) has recently been performed in elderly patients. Unlike other reported procedures, we used the endoscope’s fixation device to ensure hemostasis because the surgeon can then use a surgical instrument with each hand. To date, there have no reports that prove lesser invasiveness or noninferiority of endoscopic surgery based on direct comparison with a large craniotomy. In this study, we investigated whether our endoscopic procedure was effective and safe. Materials and Methods. We performed 6 cases of endoscopic surgical procedures in elderly patients over the past year. First, our surgical outcomes were evaluated. Second, the outcomes were compared between our endoscopic surgery and our large craniotomy procedures. Third, the outcomes were compared between our endoscopic surgery and other reported endoscopic surgeries. Results. The outcomes of our endoscopic surgery were generally satisfactory without complications or rebleeding. Mean hematoma evacuation percentage was 91.6 ± 4%. Compared with a large craniotomy, operative time was significantly shorter ( P = .01), and the hospital costs were significantly less for endoscopic surgery ( P = .008). There was no inferiority of outcomes when compared with other reported endoscopic surgeries. Conclusion. Our surgical procedure is safe and effective when performed with strict operative indications. Endoscopic surgery for ASDH in elderly adults may be an alternative to a large craniotomy in simple-type hematomas.

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Clinical Analysis of Hospital-acquired Bloodstream Infection in the Elderly

Journal of Geriatric Medicine ◽

10.30564/jgr.v1i01.728 ◽

2019 ◽

Vol 1 (01) ◽

Author(s):

Baojun Sun

Keyword(s):

Risk Factors ◽

Renal Insufficiency ◽

Elderly Patients ◽

Bloodstream Infection ◽

Sofa Score ◽

Chronic Renal Insufficiency ◽

Bloodstream Infections ◽

The Elderly ◽

Independent Risk Factors ◽

Hospital Acquired

Objective: This study was designed to get epidemiological characteristics, etiology characteristics, prognosis assessment and prognostic factors of hospital-acquired bloodstream infection (HABSI) in the elderly in Chinese PLA General Hospital and aimed at providing a reference for HABSI in the elderly on clinical diagnosis and treatment to improve the prognosis. Methods: The clinical data and pathology data of 210 cases of the elderly patients with HABSI from 2009 to 2012 in geriatric wards were retrospectively analyzed. Compare the clinical assessment effects of APACHE-II score, SAPS-II score and SOFA score to HABSI prognosis in the elderly by plotting the receiver operating characteristic curve. Use univariate and multivariate logistic regression analysis to get prognostic factors of HABSI in the elderly. Results: Univariate analysis of mortality: Day 1 apache -> 18 II score, lung infection, invasive ventilation, chronic hepatic insufficiency, chronic renal insufficiency, substantive organ malignant tumor, deep venipuncture, indwelling gastric tube indwelling ureter, complicated with shock and acquired bloodstream infections in the elderly patients with 7 days survival state association is significant. Day-1 SOFA score>7, chronic liver dysfunction, chronic renal insufficiency, concurrent shock, hemodialysis and 28-day survival status of patients with acquired bloodstream infection in elderly hospitals were significantly associated. Multivariate unconditioned logistic regression analysis related to death: Day-1APACHE-II score>18, parenchymal malignant tumors, and concurrent shock are independent risk factors for 7-day death in elderly patients with acquired bloodstream infection. Day-1 SOFA score>7, chronic renal insufficiency, and concurrent shock are independent risk factors for 28-day mortality in elderly patients with acquired bloodstream infection. Conclusion: The incidence of acquired bloodstream infections in the elderly was 1.37%. The 7-day and 28-day mortality rates were 8.10% and 22.38%, respectively. Concurrent shock is 26.7%. The 28-day mortality rate of concurrent shock patients was 48.21%. The best outcome score for the 7-day prognosis of elderly patients with acquired bloodstream infection was the Day-1APACHE-II score, followed by the Day-1 SOFA score. The best score for the 28-day prognostic assessment was the Day-1 SOFA score.

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Clinical Analysis of Hospital-acquired Bloodstream Infection in the Elderly

Journal of Geriatric Medicine ◽

10.30564/jgm.v1i01.728 ◽

2019 ◽

Vol 1 (1) ◽

Author(s):

Baojun Sun

Keyword(s):

Risk Factors ◽

Renal Insufficiency ◽

Elderly Patients ◽

Bloodstream Infection ◽

Sofa Score ◽

Chronic Renal Insufficiency ◽

Bloodstream Infections ◽

The Elderly ◽

Independent Risk Factors ◽

Hospital Acquired

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Analysis of Effectiveness, Safety, and Bleeding Related to Rivaroxaban in Elderly Patients

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029620925923 ◽

2020 ◽

Vol 26 ◽

pp. 107602962092592

Author(s):

Huimin Hou ◽

Ang Li ◽

Liping Zhang ◽

Xiujiao Qin ◽

Yanfang Jiang ◽

...

Keyword(s):

Risk Factors ◽

Elderly Patients ◽

Multivariate Logistic Regression Analysis ◽

The Elderly ◽

Multivariate Logistic Regression ◽

Bleeding Events ◽

Old Patients ◽

Daily Dose ◽

Independent Risk Factors ◽

Different Doses

This study explored the efficacy and safety of rivaroxaban in elderly patients, at different doses and age of patients, and analyzed risk factors of bleeding. A retrospective analysis was conducted of 299 patients aged 60 years or older who were admitted to the First Hospital of Jilin University between January 2016 and August 2018. It was found that the rate of bleeding events (but not embolism) significantly increased as the dose of oral rivaroxaban increased ( P < .001), and with age, especially in patients aged ≥80 years ( P = .001, both). The multivariate logistic regression analysis indicated that age (odds ratio [OR]: 2.963, 95% CI: 1.627-5.396) and the daily dose of rivaroxaban (OR: 2.325, 95% CI: 1.483-3.645) were independent risk factors for bleeding. The study determined that rivaroxaban anticoagulant therapy is effective in the elderly patients, but the risk of bleeding increases with age, and is a concern especially in the most old patients. The recommended daily dose of rivaroxaban is effective, but a lower dose is safer for the elderly patients.

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Clinical Relevance of Seizure in Pediatric Patients with Isolated Acute Subdural Hematoma without Parenchymal Brain Injury

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0039-1677824 ◽

2019 ◽

Vol 80 (04) ◽

pp. 233-239 ◽

Cited By ~ 1

Author(s):

Sae-Yeon Won ◽

Daniel Dubinski ◽

Bedjan Behmanesh ◽

Adam Strzelczyk ◽

Volker Seifert ◽

...

Keyword(s):

Risk Factors ◽

Subdural Hematoma ◽

Pediatric Patients ◽

Acute Subdural Hematoma ◽

Midline Shift ◽

Hematoma Volume ◽

Injury Score ◽

Antiepileptic Treatment ◽

Baseline Characteristics

Purpose Isolated acute subdural hematoma (aSDH) in pediatric patients is rare, but it has a major impact on outcome. The purpose of this study was to determine incidence, seizure risk factors, and the outcome of pediatric patients with aSDH. Methods Within a 10-year period (2007–2016), 10 children with aSDH were identified. Baseline characteristics and these parameters were analyzed: pediatric Glasgow Coma Scale (pGCS) score at admission and 24 hours after the operation, hematoma volume/side, and midline shift. Functional outcome was assessed at 3-month follow-up using the King's Outcome Scale for Childhood Head Injury score. Results Three subgroups were identified depending on age and etiology: birth-associated, nontraumatic, and traumatic aSDH. The overall incidence of seizures was 60%, and an even higher rate (75%) was observed in children < 1 month of age. Of those patients, two (67%) developed late seizures. Significant predictors for seizures were low pGCS score at admission (p = 0.03) and 24 hours after surgery (p = 0.03) as well as increased midline shift (p = 0.02). Patients with seizures tended to have an unfavorable outcome. Conclusion Pediatric patients with aSDH are at high risk for seizures, particularly if the pGCS score is low at admission/24 hours after the operation and midline shows a shift. Determining seizure-prone pediatric patients may facilitate early antiepileptic treatment and promote better clinical outcomes.

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ThE Prognostic Role of Comorbidities in Older Patients Qualified for Emergency Abdominal Surgery

Polish Journal of Surgery ◽

10.1515/pjs-2015-0003 ◽

2015 ◽

Vol 86 (12) ◽

Cited By ~ 1

Author(s):

Jakub Kenig ◽

Piotr Richter ◽

Urszula Olszewska ◽

Beata Żychiewicz

Keyword(s):

Risk Factors ◽

Abdominal Surgery ◽

Elderly Patients ◽

Renal Disease ◽

Vascular Disease ◽

Odds Ratio ◽

Prognostic Role ◽

Independent Risk Factors ◽

Emergency Abdominal Surgery

AbstractUntil now, the literature about the influence of specific comorbid conditions on outcome of emergency abdominal surgery in polish elderly patients is scars.was to determine the prognostic role of comorbidities in patients qualified for emergency abdominal surgery.. One hundred and eighty four consecutive patients(98 female and 86 male). 65 years of age were prospectively enrolled. The mean age was 76.9±5.8 (range 65-100) years old.. Only 16% of patients did not have any preoperative comorbidity. The 30-day mortality was 24.5% (45 patients). The 30-day morbidity was experienced by the 58.7% (108 patients), including 40 patients (21.7%) with minor complications and 68 patients (37%) with major complications, according to the Clavien-Dindo complications scale.The dysrhythmia (odds ratio 1.6, 95% CI 1.2-2.6, p=0.02), vascular disease (odds ratio 2.1, 95% CI 1.4- 3.1, p=0.02) and renal disease (odds ratio 1.4, 95% CI 1.2-2.8, p=0.01) were independent risk factors of 30-day morbidity. The vascular disease was also the independent risk factor of 30-day postoperative death in the multivariate regression analysis (odds ratio 1.9, 95% CI 1.3-2.8, p=0.001).Preoperative comorbidities are common among elderly patients qualified for emergency abdominal surgery. However, only some of them (the dysrhythmia, the vascular disease and the renal disease) are independent risk factors of postoperative adverse outcomes. Therefore, number of comorbidies alone should not be the reason for a limited treatment.

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HsCRP Variation is the Main Risk Factor for Clinical Outcome in COVID-19 Hospitalized Young and Middle-Aged Patients

10.21203/rs.3.rs-40110/v1 ◽

2020 ◽

Author(s):

Zhelong Liu ◽

Danning Wu ◽

Xia Han ◽

Wangyan Jiang ◽

Lin Qiu ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Elderly Patients ◽

Clinical Characteristics ◽

The Elderly ◽

Middle Aged ◽

Aged Patients ◽

Icu Admission ◽

Discharged Patients ◽

Independent Risk Factors

Abstract Background: The clinical characteristics and risk factors of clinical outcomes of COVID-19 in elderly and non-elderly patients show great difference. We are the first to explore the relationship between hsCRP variation and intensive care unit (ICU) admission in young and middle-aged COVID-19 patients compared with elderly patients.Methods: We included 273 hospitalized patients with confirmed COVID-19 from Tongji Hospital, Wuhan, China from Feb 10, 2020 to Mar 8, 2020. Clinical characteristics and risk factors of outcomes were compared between young and middle-aged patients with elderly patients.Results: Among young and middle-aged patients, hsCRP variation in those admitted to ICU was significantly higher than that in discharged patients. Among patients admitted to ICU, hsCRP variation showed significantly difference between young and middle-aged patients and elderly patients (median, 67.9 vs -10.2, P < 0.01). The hsCRP variation was an independent risk factor for ICU admission in young and middle-aged patients (OR = 1.068) and ROC curve revealed hsCRP variation significant for the prediction of ICU admission (AUC = 0.925) with 92.9% sensitivity and 95.5% specificity. Conclusion: HsCRP variation is the major independent risk factors for ICU admission in young and middle-aged COVID-19 inpatients, but not in the elderly patients.

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A New Preoperative Risk Score for Predicting Postoperative Complications in Elderly Patients Undergoing Hepatectomy

World Journal of Surgery ◽

10.1007/s00268-021-05985-w ◽

2021 ◽

Author(s):

Koichi Tomita ◽

Itsuki Koganezawa ◽

Masashi Nakagawa ◽

Shigeto Ochiai ◽

Takahiro Gunji ◽

...

Keyword(s):

Risk Factors ◽

Skeletal Muscle ◽

Postoperative Complications ◽

Elderly Patients ◽

Risk Score ◽

Surgical Procedure ◽

Evaluation Method ◽

Preoperative Risk ◽

Preoperative Serum ◽

Independent Risk Factors

Abstract Background Postoperative complications are not rare in the elderly population after hepatectomy. However, predicting postoperative risk in elderly patients undergoing hepatectomy is not easy. We aimed to develop a new preoperative evaluation method to predict postoperative complications in patients above 65 years of age using biological impedance analysis (BIA). Methods Clinical data of 59 consecutive patients (aged 65 years or older) who underwent hepatectomy at our institution between 2017 and 2020 were retrospectively analyzed. Risk factors for postoperative complications (Clavien-Dindo ≥ III) were evaluated using multivariate regression analysis. Additionally, a new preoperative risk score was developed for predicting postoperative complications. Results Fifteen patients (25.4%) had postoperative complications, with biliary fistula being the most common complication. Abnormal skeletal muscle mass index from BIA and type of surgical procedure were found to be independent risk factors in the multivariate analysis. These two variables and preoperative serum albumin levels were used for developing the risk score. The postoperative complication rate was 0.0% with a risk score of ≤ 1 and 57.1% with a risk score of ≥ 4. The area under the receiver operating characteristic curve of the risk score was 0.810 (p = 0.001), which was better than that of other known surgical risk indexes. Conclusion Decreased skeletal muscle and the type of surgical procedure for hepatectomy were independent risk factors for postoperative complications after elective hepatectomy in elderly patients. The new preoperative risk score is simple, easy to perform, and will help in the detection of high-risk elderly patients undergoing elective hepatectomy.

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