EPIDEMIOLOGY AND PROGNOSTIC FACTORS IN PATIENTS WITH SUBDURAL HEMATOMA

Abstract

SDH was first described in 1658 and in 1914 trauma was recognized as one of the causes. Acute SDH is more common in younger population while chronic is common in the elderly with the peak of incidence of 7.35/100000 per year in the age group 70-79 years. Trauma is one of the main causes of SDH although in 30-50% of patients direct trauma to the head can be omitted. Other predisposing factors include: anticoagulant therapy, epilepsy, and hypertension. The aim of the study was to determine risk factors and prognostic factors for the occurrence of SDH, also to show what age group  is most at risk for developing chronic and acute SDH. Identify the diagnostic steps in proving SDH and the best method of treatment. The study includes 267 patients treated in the period from 1.1.2019 to 31.12.2019 at the Clinic for Neurosurgery CCS. SDH was diagnosed by neurological examination and brain CT in all patients and all were treated conservatively or surgically. The analytical statistics were used parametric and non-parametric tests of difference. The study included 185 men and 82 women of middle age 68 ± 17.19 years. Most patients were between 6-8 decades. Multiple changes in  CT were observed in 63.3% of patients. Chronic SDH had 50.5% of patients and 45.6% had acute SDH. The most common symptoms were headache, psycho-organic syndrome, and hemiparesis. Patients with a GCS score of more than 8 had a better prognosis and outcome. Surgical treatment was the main course of treatment in our study. CT with / without contrast is the gold standard in detecting SDH. Men are at higher risk for the occurrence of SDH. Symptoms can occur later in the clinical presentation so we need to take caution when performing neurological examination. Factors that can lead us to suspect possible SDH are: age, gender, type of injury, clinical presentation, and time of occurrence.