51A REVIEW OF MANAGEMENT AND OUTCOME OF CHRONIC SUBDURAL HAEMATOMA IN THE ELDERLY

Abstract

Introduction: Chronic subdural hematoma (CSDH) predominantly occurs in elderly and often follows minor head injuries. Diagnosis may be difficult in elderly who may not even recollect any history of trauma which usually precedes weeks to months. Presentation could be varied and nonspecific and may be difficult to differentiate from other causes of delirium/dementia. We did a retrospective study to evaluate the incidence, clinical presentation, management and outcome of CSDH in older patients admitted to our hospital. Methods: Patients with age ≥65 years and radiological evidence of CSDH were identified from radiology database over a period of 12 months. Acute or acute on CSDH were excluded. Electronic discharge letters follow-up letters and radiological images were reviewed. Outcome with regards to discharge destination, mortality, and readmission within 30 days were noted. Results: 49 patients, mean ages 83 years (range 65-98), mostly (35) with unilateral haematoma were identified. The incidence of CSDH was 8.16 /100,000. Presentations were widely varied with falls being the commonest (29) followed by headache (6), confusion (5) and collapse (3). 28 (54%) patients were on anticoagulants or antiplatelet .13 underwent surgical intervention whereas 36 were treated conservatively. 47 were discharged and 37 went home. (Table presented) Conclusions: The incidence of CSDH in our study is relatively higher which may be due to low threshold for imaging in patients with recurrent falls and confusion, high use of anticoagulant/ antiplatelet and increasing age. Over half our patients were on anticoagulant or antiplatelets, which predisposes to risk of CSDH and recurrent bleed. Majority were managed conservatively either because unfit for surgery or small haematoma but the overall incidence of neuro-related readmissions and mortality were higher in conservatively treated group. It also implies need for comprehensive geriatric assessment in this group, which may help to stratify and optimize patients for surgical intervention and rationalise use of anticoagulants/ antiplatelet in frailer older people particularly with recurrent falls.