Browsing by Subject "Chronic subdural hematoma"

Sort by: Order: Results:

Now showing items 1-2 of 2
  • Tommiska, Pihla; Korja, Miikka; Siironen, Jari; Kaprio, Jaakko; Raj, Rahul (2020)
    Background dementia is associated with an excess risk of death but mortality after chronic subdural hematoma (CSDH) evacuation in older people with dementia is unknown. We assessed the association between dementia and 1-year case-fatality in older persons undergoing CSDH evacuation. Methods we conducted a nationwide Finnish cohort study including all older persons (≥60 years) undergoing CSDH evacuation during 1997–2014 (referred to as cases). We identified controls, without a diagnosis of CSDH, that were matched for age, sex and year of first hospitalisation with a new dementia diagnosis. We identified cases and controls with a pre-existing diagnosis of dementia. Outcome was 12-month mortality. Mortality was compared in case-only and case–control analyses. Results of 7,621 included cases, 885 (12%) had a pre-existing diagnosis of dementia. The proportion of cases increased from 9.7% in 1997–2002 to 12.2% in 2012–2014 (P = 0.038 for trend). In the case-analysis, dementia independently associated with 1-year case-fatality (dementia vs. no dementia odds ratio [OR] 1.50, 95% confidence interval [CI] 1.26–1.78). Sensitivity analysis suggested the association to be strongest for those 60–69 years old (OR 3.21, 95% CI 1.59–6.47). In the case–control matched analysis, 1-year mortality was 26% in the dementia CSDH surgery group compared to 16% in the dementia non-CSDH controls (P < 0.001). Conclusion dementia is a significant risk factor for 1-year mortality after CSDH surgery in older people. The proportion of older CSDH patients having a pre-existing diagnosis of dementia is increasing. Thus, there is a need for improved evidence regarding the indications and benefits of CSDH evacuation among older persons.
  • Tommiska, Pihla; Lonnrot, Kimmo; Raj, Rahul; Luostarinen, Teemu; Kivisaari, Riku (2019)
    BACKGROUND: A number of randomized controlled trials have shown the benefit of drain placement in the operative treatment of chronic subdural hematoma (CSDH); however, few reports have described real-life results after adoption of drain placement into clinical practice. We report the results following a change in practice at Helsinki University Hospital from no drain to subdural drain (SD) placement after burr hole craniostomy for CSDH. METHODS: We conducted a retrospective observational study of consecutive patients undergoing burr hole craniostomy for CSDH. We compared outcomes between a 6-month period when SD placement was arbitrary (Julye December 2015) and a period when SD placement for 48 hours was routine (July-December 2017). Our primary outcome of interest was recurrence of CSDH necessitating reoperation within 6 months. Patient outcomes, infections, and other complications were assessed as well. RESULTS: A total of 161 patients were included, comprising 71 (44%) in the drain group and 90 (56%) in the non-drain group. There were no significant differences in age, comorbidities, history of trauma, or use of antithrombotic agents between the 2 groups (P > 0.05 for all). Recurrence within 6 months occurred in 18% of patients in the non-drain group, compared with 6% in the drain group (odds ratio, 0.28; 95% confidence interval, 0.09-0.87; P = 0.028). There were no differences in neurologic outcomes (P = 0.72), mortality (P = 0.55), infection rate (P = 0.96), or other complications (P = 0.20). CONCLUSIONS: The change in practice from no drain to use of an SD after burr hole craniostomy for CSDH effectively reduced the 6-month recurrence rate with no effect on patient outcomes, infections, or other complications.