Factors that negatively influence the Glasgow Outcome Scale in patients with chronic subdural hematomas. An analytical and retrospective study in a tertiary center

Abstract

Background: Subdural hematomas are one of the most frequent types of intracranial hemorrhage, but there are very few references to explain how different factors can influence the prognosis of these patients. We have tried to establish with statistical significance several elements that influence the Glasgow Outcome Scale at 12 months of follow-up. Methods: We have collected clinical data from January 2008 to January 2018 of all patients admitted to our hospital with a diagnosis of Subdural Hematoma. We classified them in Chronic Subdural Hematoma, Subdural Subacute Chronic Hematoma and Chronic Subdural Hematoma with acute bleeding. From the collected cases, various demographic characteristics, clinical and pharmacological background, radiological, surgical, follow-up and prognostic features were defined, and a statistical analysis was performed to look for significant variables. Results: A total of 281 patients were analyzed, after performing the statistical analysis (univariate and multivariate analysis) of the multiple variables of the population, statistically significant associations were found in relation to unfavourable GOS at 12 months for the following sections: age, Glasgow Coma Scale on admission, Glasgow Outcome Scale on admission, midline deviation, use of anticoagulant and antiplatelet treatment and intrahematoma septae. Conclusions: Chronic subdural hematomas, in a high percentage, are subsidiary of surgical treatment. There are several factors that negatively influence the prognosis in patients and that should be considered for both the surgical decision and patient/family agreement and for the medium/long-term follow-up of them.