Bo Bergholt

The Danish chronic subdural hematoma study-predicting recurrence of chronic subdural hematoma

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • Nina Christine Andersen-Ranberg, Department of Neurosurgery, Rigshospitalet University Hospital, Copenhagen.
  • ,
  • Birgit Debrabant, University of Southern Denmark
  • ,
  • Frantz Rom Poulsen, Department of Neurosurgery, Odense University Hospital, Odense.
  • ,
  • Bo Bergholt
  • Torben Hundsholt, Aalborg University
  • ,
  • Kåre Fugleholm, Department of Neurosurgery, Rigshospitalet University Hospital, Copenhagen.

BACKGROUND: An increasing incidence of chronic subdural hematoma (CSDH) and an unchanging high recurrence rate of 10-20% call for individualized treatment. The aim of this study was to establish individualized prediction models for the risk of recurrence treating death as a competing risk.

METHODS: A retrospective national cohort of unilateral CSDH was included for analysis. Using competing risk survival analysis, we tested whether available covariates were associated with the risk of recurrence. We further established a pre- and a postoperative prediction model, where predictors were chosen using a LASSO approach. The models were visualized in nomograms. Predictive performance was evaluated by c index and calibrations plots.

RESULTS: A total of 763 patients with surgically evacuated unilateral CSDH were included for analysis. The recurrence rate was 14% while 12% of patients died during follow-up (1 year). In our association model, hematoma size, drain type, drainage time, presence of complications, and Glasgow Coma Score were significantly associated to recurrence. Subdural drain was associated with a lower recurrence risk than subgaleal drain. The preoperative model included hematoma size, hematoma density, and history of hypertension. The postoperative model included further drain type, drainage time, and surgical complications.

CONCLUSION: The nomograms allow easy assessment of the recurrence risk for the individual patient, providing a better possibility for individual adjustment of treatment and follow-up. The predictive performance indicates that significant unaccounted or unknown factors still remain. The association test found passive subdural drain superior to passive subgaleal drain in minimizing the risk of CSDH recurrence.

Original languageEnglish
JournalActa Neurochirurgica
Volume161
Issue5
Pages (from-to)885-894
Number of pages10
ISSN0001-6268
DOIs
Publication statusPublished - May 2019

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