Functional Outcome of Chronic Subdural Hemorrhage on Glasgow Comatose Outcome Scale Extended

Authors

  • Abdul Rauf Memon Department of Neurosurgery, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro
  • Muzafar Ali Bhand Department of Neurosurgery, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro
  • Sanaullah Pathan
  • Suhail Ahmed Aghani
  • Hameedullah Khan
  • Peer Asad Aziz Department of Neurosurgery, Bilawal Medical Collage, Jamshoro
  • Zeeshan Nasir Department of Neurosurgery, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro

DOI:

https://doi.org/10.36552/pjns.v29i1.1088

Abstract

Objectives:  Chronic Subdural hemorrhage is one of the most common neurosurgical disorders, mainly affecting the older population. The main objective is to assess the functional outcome of patients with Chronic Subdural hematoma on GCOSE.

Materials and Methods:  This is a prospective cross-sectional study conducted at Liaquat University Hospital Hyderabad with a duration of January to December 2023. Patients presented with CSDH and different management was performed at the time of discharge or death GCOSE scale was recorded on a predesigned questionnaire.

Results:  A total of 63 patients were included in the study, the mean age was 58.26, of which 69.8% were males, the most common presentation was One-sided weakness 58.9%, followed by the altered level of consciousness 57.3%. The mean pre and postoperative GCS was 10.98 and 11.87 respectively. Most of the patients had unilateral collection 89% with a few having bilateral CSDH 11%. The outcome GCOSE was such that 50% of the patients were found in grade VIII i.e. upper good recovery, all the patients that underwent through and through drainage had the best outcome with a p-value of 0.001, however, 22% of the patients were found in grade I (dead).

Conclusion:  The functional outcome of Chronic subdural hematoma is best delineated with GCOSE as compared to the modified ranking scale and GOS.

Keywords:  CSDH, functional outcome, GCS, GCOSE, head trauma, Glasgow outcome scale, Glasgow outcome scale extended, modified ranking scale.

References

El-Rahal A, Beck J, Ahlborn P, Bernasconi C, Marbacher S, Wanderer S, et al. Incidence, therapy, and outcome in the management of chronic subdural hematoma in Switzerland: a population-based multicenter cohort study. Frontiers in Neurology. 2023;14.

DOI: 10.3389/fneur.2023.1206996.

Pathan S, Memon AR, Aziz PA, Bhand MA, Aghani SA, Khan H, et al. Outcome Difference Between Traumatic and Spontaneous Chronic Subdural Hematoma. Pakistan Journal Of Neurological Surgery. 2024;28(2):203-10.

DOI: 10.36552/pjns.v28i2.961.

González-Vargas PM, Thenier-Villa JL, Félix LC, Campoverde RAG, Martín-Gallego Á, de la Lama Zaragoza A, et al. Factors that negatively influence the Glasgow Outcome Scale in patients with chronic subdural hematomas. An analytical and retrospective study in a tertiary center. Interdisciplinary Neurosurgery. 2020;20:100606.

DOI.:10.1016/j.inat.2019.100606.

Sharafat S, Khan Z, ul Haq N. The Incidence And Different Risk Factors For The Recurrence Of Chronic Subdural Hematoma: A Retrospective Study. Journal of Pharmaceutical Negative Results. 2022:1117-24. Doi: 10.47750/pnr.2022.13.S08.141.

Chon K-H, Lee J-M, Koh E-J, Choi H-Y. Independent predictors for recurrence of chronic subdural hematoma. Acta neurochirurgica. 2012;154:1541-8. Doi.: 0.1007/s00701-012-1399-9.

Chen H, Colasurdo M, Malhotra A, Gandhi D, Bodanapally UK. Advances in chronic subdural hematoma and membrane imaging. Front Neurol. 2024;15:1366238.

DOI: 10.3389/fneur.2024.1366238.

Blaauw J, Meelis GA, Jacobs B, van der Gaag NA, Jellema K, Kho KH, et al. Presenting symptoms and functional outcome of chronic subdural hematoma patients. Acta Neurol Scand. 2022;145(1):38-46.

DOI. 10.1111/ane.13518.

Merrill SA, Khan D, Richards AE, Kalani MA, Patel NP, Neal MT. Functional recovery following surgery for chronic subdural hematoma. Surgical Neurology International. 2020;11.

DOI: 10.25259/SNI_689_2020.

Bhand MA, Pathan S, Khan H, Aziz PA, Hyder W, Mehmood A, et al. Modified Nakaguchi Classification: Is it a New Way to Measure Outcome of Chronic Subrural Hematoma through GCOSE? Pakistan Journal Of Neurological Surgery. 2024;28(4):468-75. Doi: 10.36552/pjns.v28i4.1052.

Soleman J, Lutz K, Schädelin S, Mariani L, Fandino

J. Use of Subperiosteal Drain Versus Subdural Drain in Chronic Subdural Hematomas Treated With Burr-Hole Trepanation: Study Protocol for a Randomized Controlled Trial. JMIR Research Protocols. 2016;5:e38. DOI: 10.2196/resprot.5339.

Ishida T, Inoue T, Inoue T, Saito A, Suzuki S, Uenohara H, et al. Functional Outcome in Patients with Chronic Subdural Hematoma: Postoperative Delirium and Operative Procedure. Neurol Med Chir (Tokyo). 2022;62(4):171-6.

DOI: 10.2176/jns-nmc.2020-0319.

Gaastra B, Ren D, Alexander S, Awad IA, Blackburn S, Doré S, et al. Evidence-based interconversion of the Glasgow Outcome and modified Rankin scales: pitfalls and best practices. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2022;31(12):106845. DOI: 10.1016/j.jstrokecerebrovasdis.2022.106845.

Nobels-Janssen E, Postma EN, Abma IL, van Dijk JMC, de Ridder IR, Schenck H, et al. Validity of the modified Rankin Scale in patients with aneurysmal subarachnoid hemorrhage: a randomized study. BMC neurology. 2024;24(1):23.

DOI. 10.1186/s12883-023-03479-x.

Nelson LD, Temkin NR, Barber J, Brett BL, Okonkwo DO, McCrea MA, et al. Functional Recovery, Symptoms, and Quality of Life 1 to 5 Years After Traumatic Brain Injury: Findings From the TRACK-TBI Study. JAMA Network Open. 2023;6(3):e233660-e.

DOI: 10.1001/jamanetworkopen.2023.3660.

Blaauw J. Clinical aspects of chronic subdural hematoma: Presentation, management and outcome. Groningen]: University of Groningen; 2024. Doi: 10.33612/diss.849060546s:

Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013;35(2):121-6.

DOI: 10.4103/0253-7176.116232.

Shen J, Shao X, Wang Q, Ge R, Zhang J. Comparison of Clinical and Radiologic Characteristics and Prognosis of Patients with Chronic Subdural Hematoma with and without a History of Head Trauma. World Neurosurg. 2019;132:e391-e8.

Doi: 10.1016/j.wneu.2019.08.142.

Rauhala M, Helén P, Seppä K, Huhtala H, Iverson GL, Niskakangas T, et al. Long-term excess mortality after chronic subdural hematoma. Acta Neurochirurgica. 2020;162:1467-78.

DOI: 10.1007/s00701-020-04398-3.

Ahmed M, Sajjad F, Khan A, Abass T, Akbar H, Anwar K. Clinical Presentation and Surgical Outcomes of Chronic Subdural Hematoma. Pakistan Journal of Neurological Surgery. 2020;24(4):369-75. DOI: 10.36552/pjns.v24i4.502.

Ou Y, Yu X, Liu X, Jing Q, Liu B, Liu W. A comparative study of chronic subdural hematoma in patients with and without head trauma: a retrospective cross sectional study. Frontiers in neurology. 2020;11:588242.

DOI: 10.3389/fneur.2020.588242.

Nouri A, Gondar R, Schaller K, Meling T. Chronic Subdural Hematoma (cSDH): A review of the current state of the art. Brain & spine. 2021;1:100300. DOI: 10.1016/j.bas.2021.100300.

Sara V, Daniel MF, Laurence JG, Laurent JL, Ian CC, Simon B, et al. Time to surgery following chronic subdural hematoma: post hoc analysis of a prospective cohort study. BMJ Surgery, Interventions, and Health Technologies. 2019;1(1):e000012.

DOI: 10.1136/bmjsit-2019-000012.

Christopher E, Poon MTC, Glancz LJ, Hutchinson PJ, Kolias AG, Brennan PM. Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma. Neurosurgical review. 2019;42(2):427-31.

DOI: 10.1007/s10143-018-0979-4.

Ahmed OEF, El Sawy A, El Molla S. Surgical management of chronic subdural hematomas through single-burr hole craniostomy: is it sufficient? The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2021;57(1):136.

Doi: 10.1186/s41983-021-00368-3.

Aljabali A, Sharkawy AM, Jaradat B, Serag I, Al-Dardery NM, Abdelhady M, et al. Drainage versus no drainage after burr-hole evacuation of chronic subdural hematoma: a systematic review and meta-analysis of 1961 patients. Neurosurgical review. 2023;46(1):251.

Doi: 10.1007/s10143-023-02153-7.

Blaauw J, Hertog HMd, Holl DC, Thüss NS, van der Gaag NA, Jellema K, et al. The cognitive status of chronic subdural hematoma patients after treatment: an exploratory study. Acta Neurochirurgica. 2023;165(3):701-9.

DOI: 10.1007/s00701-023-05508-7.

Blaauw J, Boxum AG, Jacobs B, Groen RJ, Peul WC, Jellema K, et al. Prevalence of cognitive complaints and impairment in patients with chronic subdural hematoma and recovery after treatment: a systematic review. Journal of Neurotrauma. 2021;38(2):159-68.

DOI: 10.1089/neu.2020.7206

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Published

2025-03-01

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