Profile and outcomes of patients admitted with chronic subdural hematomas - A single center report from an Academic Hospital in Pretoria, Gauteng, South Africa

Aim: Chronic subdural hematomas are a relatively common condition defined as an abnormal collection of blood and its break down products in the subdural space. We aimed to determine the significance of pre-operative clinical and operative variables in predicting outcome in 128 patients admitted over a 5 year period with chronic subdural hematomas whom went for operative intervention. Methods: Retrospective data analysis of 128 patients admitted with chronic subdural hematomas from January 2009 to December 2013 was performed. Medical records were analyzed for patient demographics, presenting symptoms, co-morbid medical conditions including history of non-steroidal anti-inflammatory drug use, presence of a ventriculo-peritoneal shunt, use of adjunctive steroids, type of operative intervention, and Glasgow Outcome Score. Management involved burr holes with or without a subdural drain or craniotomy. Results: Considering all of the variables, significance was demonstrated between the presenting Glasgow Coma Score and outcome (p = 0.002), as well as between the presenting Markwalder Score and outcome (p = 0.003). Further significant variables demonstrated included chronic subdural hematomas occurring secondary to an over-draining ventriculo-peritoneal shunt (p = 0.008) and when the presenting symptoms included a seizure (p = 0.009). Neither a pre-morbid history of hypertension, diabetes mellitus, ischemic heart disease, non-steroidal anti-inflammatory drug use, nor alcohol abuse, demonstrated significance. In terms of management neither the use of adjunctive steroids nor the type of surgery performed demonstrated significance. Conclusion: Considering patients with chronic subdural hematomas our study demonstrated that the significant variables predicting outcome are chronic subdural hematomas occurring secondary to an overdraining ventriculo-peritoneal shunt, a history of seizures, and a low level of consciousness measured by either the Markwalder or the Glasgow Coma Score. Interestingly all of these variables are determined prior to the patient arriving at hospital. Our study highlights the need for early presentation prior to clinical deterioration as the major determinant of outcome.