Presenting symptoms and functional outcome of chronic subdural hematoma patients

• Published in: Acta neurologica Scandinavica Vol. 145; no. 1; pp. 38 - 46
• Main Authors: Blaauw, Jurre, Meelis, Ghislaine A., Jacobs, Bram, Gaag, Niels A., Jellema, Korné, Kho, Kuan H., Groen, Rob J.M., Naalt, Joukje, Lingsma, Hester F., den Hertog, Heleen M.
• Format: Journal Article
• Language: English
• Published: Denmark Hindawi Limited 01-01-2022
• Subjects: Aged; Blood; Brain; chronic subdural hematoma; cognition; Cognitive ability; Dura mater; functional outcome; Glasgow Coma Scale; Glasgow Outcome Scale; Headache; Hematoma; Hematoma, Subdural, Chronic - complications; Hematoma, Subdural, Chronic - diagnosis; Humans; Male; Meninges; Patients; presenting symptoms; Retrospective Studies; Treatment Outcome; chronic subdural hematoma; functional outcome; cognition; presenting symptoms
• ISSN: 0001-6314; 1600-0404
• DOI: 10.1111/ane.13518

Background
Patients with chronic subdural hematoma (CSDH) can present with a variety of signs and symptoms. The relationship of these signs and symptoms with functional outcome is unknown. Knowledge of these associations might aid clinicians in the choice to initiate treatment and may allow them to better inform patients on expected outcomes.
Objective
To investigate if presenting signs and symptoms influence functional outcome in patients with CSDH.
Methods
We conducted a retrospective analysis of consecutive CSDH patients in three hospitals. Glasgow Outcome Scale Extended (GOS‐E) scores were obtained from the first follow‐up visit after treatment. An ordinal multivariable regression analysis was performed, to assess the relationship between the different signs and symptoms on the one hand and functional outcome on the other adjusted for potential confounders.
Results
We included 1,307 patients, of whom 958 (73%) were male and mean age was 74 (SD ± 11) years. Cognitive complaints were associated with lower GOS‐E scores at follow‐up (aOR 0.7, 95% CI: 0.5 – 0.8) Headache and higher Glasgow Coma Scale (GCS) scores were associated with higher GOS‐E scores. (aOR 1.9, 95% CI: 1.5–2.3 and aOR 1.3, 95% CI: 1.2–1.4).
Conclusion
Cognitive complaints are independently associated with worse functional outcome, whereas headache and higher GCS scores are associated with better outcome. The increased probability of unfavorable outcome in patients with CSDH who present with cognitive complaints favors a more prominent place of assessing cognitive status at diagnosis.