TY - JOUR
T1 - Predictors of Mortality, Withdrawal of Life-Sustaining Measures, and Discharge Disposition in Octogenarians with Subdural Hematomas
AU - the American Association for the Surgery of Trauma GERI-TBI Study Group
AU - Kashkoush, Ahmed
AU - Petitt, Jordan C.
AU - Ladhani, Husayn
AU - Ho, Vanessa P.
AU - Kelly, Michael L.
AU - Ghneim, Mira
AU - Albrecht, Jennifer S.
AU - Brasel, Karen
AU - Livaris, Anna
AU - Watras, Jill B.
AU - Michetti, Christopher P.
AU - Haan, James M.
AU - Lightwine, Kelly
AU - Winfield, Robert D.
AU - Adams, Sasha D.
AU - Podbielski, Jeanette M.
AU - Armen, Scott B.
AU - Zacko, J. Christopher
AU - Nasrallah, Fady S.
AU - Schaffer, Kathryn B.
AU - Dunn, Julie
AU - Widdel, Lars
AU - Schroeppel, Thomas J.
AU - Stillman, Zachery
AU - Cooper, Zara
AU - Stein, Deborah
AU - Adams, Charles
AU - Lueckel, Stephanie
AU - Murry, Jason
AU - Patel, Nikita
AU - Hsu, Cindy
AU - Bhatti, Umer F.
AU - Lissauer, Matthew E.
AU - LaFonte, Marc
AU - Najafi, Kaveh
AU - Lewandowski, Karen
AU - Mukherjee, Kaushik
AU - Imperio-Lagabon, Kristelle J.
AU - Martin, Niels D.
AU - Hirsch, Kathleen
AU - Berry, Cherisse
AU - Freitas, Derek
AU - Cullinane, Daniel
AU - Ramawi, Roshini
AU - Truitt, Michael
AU - Pearcy, Chris
AU - Hashimi, Habiba
AU - Kaups, Krista
AU - Claridge, Jeffrey
AU - Joseph, Bellal
N1 - Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2022/1
Y1 - 2022/1
N2 - Objective: Risk factors for mortality in patients with subdural hematoma (SDH) include poor Glasgow Coma Scale (GCS) score, pupil nonreactivity, and hemodynamic instability on presentation. Little is published regarding prognosticators of SDH in the elderly. This study aims to examine risk factors for hospital mortality and withdrawal of life-sustaining measures in an octogenarian population presenting with SDH. Methods: A prospectively collected multicenter database of 3279 traumatic brain injury admissions to 45 different U.S. trauma centers between 2017 and 2019 was queried to identify patients aged >79 years old presenting with SDH. Factors collected included baseline demographic data, past medical history, antiplatelet/anticoagulant use, and clinical presentation (GCS, pupil reactivity, injury severity scale [ISS]). Primary outcome data included hospital mortality/discharge to hospice care and withdrawal of life-sustaining measures. Multivariate logistic regression analyses were used to identify factors independently associated with primary outcome variables. Results: A total of 695 patients were isolated for analysis. Of the total cohort, the rate of hospital mortality or discharge to hospice care was 22% (n = 150) and the rate of withdrawal of life-sustaining measures was 10% (n = 66). A multivariate logistic regression model identified GCS <13, pupil nonreactivity, increasing ISS, intraventricular hemorrhage, and neurosurgical intervention as factors independently associated with hospital mortality/hospice. Congestive heart failure (CHF), hypotension, GCS <13, and neurosurgical intervention were independently associated with withdrawal of life-sustaining measures. Conclusions: Poor GCS, pupil nonreactivity, ISS, and intraventricular hemorrhage are independently associated with hospital mortality or discharge to hospice care in patients >80 years with SDH. Pre-existing CHF may further predict withdrawal of life-sustaining measures.
AB - Objective: Risk factors for mortality in patients with subdural hematoma (SDH) include poor Glasgow Coma Scale (GCS) score, pupil nonreactivity, and hemodynamic instability on presentation. Little is published regarding prognosticators of SDH in the elderly. This study aims to examine risk factors for hospital mortality and withdrawal of life-sustaining measures in an octogenarian population presenting with SDH. Methods: A prospectively collected multicenter database of 3279 traumatic brain injury admissions to 45 different U.S. trauma centers between 2017 and 2019 was queried to identify patients aged >79 years old presenting with SDH. Factors collected included baseline demographic data, past medical history, antiplatelet/anticoagulant use, and clinical presentation (GCS, pupil reactivity, injury severity scale [ISS]). Primary outcome data included hospital mortality/discharge to hospice care and withdrawal of life-sustaining measures. Multivariate logistic regression analyses were used to identify factors independently associated with primary outcome variables. Results: A total of 695 patients were isolated for analysis. Of the total cohort, the rate of hospital mortality or discharge to hospice care was 22% (n = 150) and the rate of withdrawal of life-sustaining measures was 10% (n = 66). A multivariate logistic regression model identified GCS <13, pupil nonreactivity, increasing ISS, intraventricular hemorrhage, and neurosurgical intervention as factors independently associated with hospital mortality/hospice. Congestive heart failure (CHF), hypotension, GCS <13, and neurosurgical intervention were independently associated with withdrawal of life-sustaining measures. Conclusions: Poor GCS, pupil nonreactivity, ISS, and intraventricular hemorrhage are independently associated with hospital mortality or discharge to hospice care in patients >80 years with SDH. Pre-existing CHF may further predict withdrawal of life-sustaining measures.
KW - Mortality
KW - Octogenarians
KW - Subdural hematoma
KW - Traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85118335320&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85118335320&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2021.09.121
DO - 10.1016/j.wneu.2021.09.121
M3 - Article
C2 - 34626845
AN - SCOPUS:85118335320
SN - 1878-8750
VL - 157
SP - e179-e187
JO - World neurosurgery
JF - World neurosurgery
ER -