Introduction
Authors | Country | Time period | n | Age mean, y (range) | Follow-up period median, y (range for survivors) | Mortality (%) | Control data | Excess mortality | |
---|---|---|---|---|---|---|---|---|---|
6 months | 1 year | ||||||||
Miranda et al. 20117 | USA | 2000–2008 | 209 | 80.6 (65–96) | 1.45 (N/A-8.3) | 26.3 | 32 | Center of Disease Control and Prevention data | • Excess mortality up to 1 year beyond diagnosis • Median survival: o CSDH 4.4 year o Anticipated actuarial survival 6 year |
Dumont et al. 20138 | USA | 1996–2010 | 287 | 75 (55-N/A) | 2.3 (0.5–14) | N/A | 30 | Center of Disease Control and Prevention data | • 1 year standardized mortality ratio: o 55–64 years:17 o 65–74 years:8.1 o 75–84 years:3.4 o ≥ 85 years:2.9 • Median survival: 4.0 ± 0.5y |
Manickam et al. 20169 | Australia | 2006–2011 | 155 | 69.3 (18-N/A) | 5.2 (N/A-14.19) | 14.19 | 20.35 | Australian Bureau of Statistics, and the Registry of Births, Deaths and Marriages | • Excess mortality throughout follow-up. • Average long-term survival: o CSDH: 5.29 ± 0.59 year o Actuarial data: 17.74 ± 1.8 year |
Guilfoyle et al. 201719 | UK | 2004–2007 | 215 | 78 (35–95) | N/A (8–10) | Drain group: 8.6 No drain group: 18.1 | N/A | Cohorts of the general population with the same number of cases and identical age and sex profiles as the drain and no drain groups (Human Mortality Database) | • 5 year cumulative excess mortality: o Drain group: 10.2% o No drain group: 22.4% |
Present study | Finland | 1990–2015 | 1133 | 73 (22–99) | 4.8 (2–27) | 9.5 | 13.7 | The population of Pirkanmaa region stratified by sex, age, and calendar year (Statistics Finland) | • Cumulative excess mortality: o 1 year: 9% o 5 years: 18% o 10 years: 27% o 15 years: 37% o 20 years: 48% |
Methods
Material and ethical aspects
Data collection
Survival analysis
Statistical analyses
Data availability statement
Results
Characteristics
Total sample n = 1133 | Non-operative treatment n = 168 | Operative treatment n = 965 | p value | ||||
---|---|---|---|---|---|---|---|
n | % | n | % | n | % | ||
Median age, years, IQR | 76 | 67–83 | 79 | 68–86 | 76 | 66–82 | 0.001 |
Sex | |||||||
Men | 736 | 65.0 | 102 | 60.7 | 634 | 65.7 | 0.21 |
Traumatic etiology | 672 | 59.3 | 107 | 63.7 | 565 | 58.5 | 0.21 |
Comorbidity | |||||||
Cardiovascular disease | 644 | 56.8 | 96 | 57.1 | 548 | 56.8 | 0.93 |
Diabetes | 178 | 15.7 | 27 | 16.1 | 151 | 15.6 | 0.89 |
Chronic alcohol abuse | 126 | 11.1 | 20 | 11.9 | 106 | 11.0 | 0.73 |
Cerebrovascular disease | 124 | 10.9 | 24 | 14.3 | 100 | 10.4 | 0.13 |
Dementia | 99 | 8.8 | 26 | 15.7 | 73 | 7.6 | 0.001 |
Pulmonary disease | 68 | 6.0 | 16 | 9.5 | 52 | 5.4 | 0.05 |
Epilepsy | 32 | 2.8 | 3 | 1.8 | 29 | 3.0 | 0.38 |
Neurodegenerative disease | 20 | 1.8 | 7 | 4.2 | 13 | 1.3 | 0.01 |
Hydrocephalus | 9 | 0.8 | 0 | 0 | 9 | 0.9 | 0.21 |
Medication | |||||||
Antiplatelet | 268 | 23.7 | 36 | 21.4 | 232 | 24.0 | 0.46 |
Warfarin | 187 | 16.5 | 26 | 15.5 | 161 | 16.7 | 0.69 |
Warfarin AND antiplatelet | 23 | 2.0 | 2 | 1.2 | 21 | 2.2 | 0.40 |
Admission GCS | |||||||
13–15 | 1007 | 88.9 | 157 | 93.5 | 850 | 88.1 | 0.04 |
9–12 | 91 | 8.0 | 8 | 4.8 | 83 | 8.6 | 0.91 |
3–8 | 35 | 3.1 | 3 | 1.8 | 32 | 3.3 | 0.29 |
Admission mRS 0–3 | 580 | 51.2 | 121 | 72.0 | 459 | 47.6 | < 0.001 |
Symptoms | |||||||
Hemiparesis | 444 | 39.2 | 9 | 5.4 | 435 | 45.1 | < 0.001 |
Vertigo or postural instability | 408 | 36.0 | 35 | 20.8 | 373 | 38.7 | < 0.001 |
Disorientation/memory impairment | 390 | 34.4 | 54 | 32.1 | 336 | 34.8 | 0.50 |
General malaise | 367 | 32.4 | 50 | 29.8 | 317 | 32.8 | 0.43 |
Headache | 340 | 30.0 | 28 | 16.7 | 312 | 32.3 | < 0.001 |
Aphasia | 245 | 21.6 | 9 | 5.4 | 236 | 24.5 | < 0.001 |
Seizure | 117 | 10.3 | 28 | 16.7 | 89 | 9.2 | 0.003 |
Nausea and/or vomiting | 60 | 5.3 | 7 | 4.2 | 53 | 5.5 | 0.48 |
Mortality after diagnosis of CSDH
Total sample n = 1133 | Men n = 736 | Women n = 397 | Age group 18–59 years n = 167 | Age group 60–79 years n = 565 | Age group ≥ 80 years n = 401 | Operative n = 965 | Non-operative n = 168 | Non-operative n = 161* | No comorbidity n = 206 | Reference group n = 4532 | ||||||||||||
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Cumulative mortality | n | % | n | % | n | % | n | % | n | % | n | % | n | % | n | % | n | % | n | % | n | % |
30 days | 38 | 3.4 | 26 | 3.5 | 12 | 3.0 | 3 | 1.8 | 15 | 2.7 | 20 | 5.0 | 25 | 2.6 | 13 | 7.7 | 8 | 5.0 | 3 | 1.5 | 16 | 0.4 |
90 days | 75 | 6.6 | 51 | 6.9 | 24 | 6.0 | 3 | 1.8 | 34 | 6.0 | 38 | 9.5 | 54 | 5.6 | 21 | 12.5 | 15 | 9.3 | 4 | 1.9 | 61 | 1.3 |
6 months | 108 | 9.5 | 74 | 10.1 | 34 | 8.6 | 5 | 3.0 | 45 | 8.0 | 58 | 14.4 | 82 | 8.5 | 26 | 15.5 | 20 | 12.4 | 6 | 2.9 | 125 | 2.8 |
1 year | 155 | 13.7 | 107 | 14.5 | 48 | 12.1 | 8 | 4.8 | 59 | 10.4 | 88 | 22.0 | 120 | 12.4 | 35 | 20.8 | 29 | 18.0 | 6 | 2.9 | 248 | 5.5 |
2 year | 254 | 22.4 | 168 | 22.8 | 86 | 21.7 | 20 | 12.0 | 97 | 17.1 | 137 | 34.2 | 200 | 20.7 | 54 | 32.1 | 47 | 29.2 | 19 | 9.2 | 486 | 10.7 |
Long-term excess mortality
Relative excess risk of death
Total sample n = 1133 | RER | 95% CI | ||
---|---|---|---|---|
n | % | |||
Sex | ||||
Men | 736 | 65.0 | 1 | Ref |
Women | 397 | 35.0 | 1.17 | 0.82–1.65 |
Age at CSDH diagnosis, years | ||||
18–59 | 167 | 14.7 | 1 | Ref |
60–79 | 565 | 49.9 | 1.05 | 0.68–1.61 |
≥ 80 | 401 | 35.4 | 1.83 | 1.11–3.02 |
Chronic alcohol abuse | ||||
No | 1007 | 88.9 | 1 | Ref |
Yes | 126 | 11.1 | 4.47 | 2.88–6.95 |
Traumatic etiology | ||||
Yes | 672 | 59.3 | 1 | Ref |
No | 461 | 40.7 | 1.69 | 1.20–2.38 |
Antithrombotic medication | ||||
None | 655 | 57.8 | 1 | Ref |
Antiplatelet | 268 | 23.7 | 1.20 | 0.72–2.01 |
Warfarin | 187 | 16.5 | 2.94 | 1.91–4.54 |
Warfarin AND antiplatelet | 23 | 2.0 | 3.24 | 1.35–7.75 |
Admission GCS | ||||
13–15 | 1007 | 88.9 | 1 | Ref |
9–12 | 91 | 8.0 | 3.53 | 2.35–5.32 |
3–8 | 35 | 3.1 | 5.71 | 3.47–9.41 |
Admission mRS | ||||
0–3 | 580 | 51.2 | 1 | Ref |
4–5 | 553 | 48.8 | 4.93 | 3.12–7.80 |
Hematoma localization | ||||
Unilateral | 876 | 77.3 | 1 | Ref |
Bilateral | 257 | 22.7 | 0.74 | 0.46–1.18 |
Hematoma thickness, mm (missing n = 23) | ||||
≤ 15 mm | 376 | 33.2 | 1 | Ref |
16–25 | 474 | 41.8 | 0.69 | 0.48–1.01 |
> 25 | 260 | 22.9 | 0.59 | 0.34–1.01 |
Operative treatment | ||||
Yes | 965 | 85.2 | 1 | Ref |
No | 168 | 14.8 | 1.77 | 1.18–2.65 |
No1 | 161 | 14.2 | 1.56 | 1.01–2.41 |
Discharge GCS2 | ||||
13–15 | 942 | 97.6 | 1 | Ref |
9–12 | 9 | 0.9 | 14.84 | 6.64–33.18 |
3–8 | 14 | 1.5 | 98.30 | 39.35–245.56 |
Discharge mRS2 | ||||
0–3 | 727 | 75.3 | 1 | Ref |
4–5 | 238 | 24.7 | 8.31 | 5.48–12.58 |
Recurrent hematoma2 | ||||
No | 692 | 71.7 | 1 | Ref |
Yes | 273 | 28.3 | 0.78 | 0.48–1.26 |
Causes of death after CSDH
Total sample n = 1133 | Men n = 736 | Women n = 397 | Operative treatment n = 965 | Non-operative treatment n = 168 | Causes of death in the matched reference group n = 4532 | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | n | % | n | % | n | % | |
Age, years (median, IQR) | 76 | 67–83 | 75 | 65–81 | 79 | 70–85 | 76 | 66–82 | 79 | 68–86 | 76 | 67–83 |
Follow-up time, years | ||||||||||||
Median | 4.8 | 5.1 | 4.6 | 5.2 | 3.3 | 6.4 | ||||||
Range | 0–27 | 0–26 | 0–27 | 0–27 | 0–21 | 0–28 | ||||||
No. of deaths | 710 | 62.7 | 449 | 61.0 | 261 | 65.7 | 609 | 62.3 | 101 | 60.1 | 1918 | 42.3 |
Age at death, median, IQR | 84 | 76–89 | 83 | 74–88 | 86 | 80–91 | 84 | 76–89 | 85 | 79–90 | 84 | 78–88 |
Ischemic cardiac disease | 143 | 20.1 | 103 | 22.9 | 40 | 15.3 | 122 | 20.0 | 21 | 20.8 | 473 | 24.7 |
Cerebrovascular disease | 90 | 12.7 | 54 | 12.0 | 36 | 13.8 | 80 | 13.1 | 10 | 9.9 | 216 | 11.3 |
Cerebral hemorrhage | 18 | 2.5 | 13 | 2.9 | 5 | 1.9 | 13 | 2.1 | 5 | 5.0 | 23 | 1.2 |
Cerebral ischemia | 72 | 10.1 | 41 | 9.1 | 31 | 11.9 | 67 | 11.0 | 5 | 5.0 | 167 | 8.7 |
Cancer | 91 | 12.8 | 64 | 14.3 | 27 | 10.3 | 80 | 13.1 | 11 | 10.9 | 370 | 19.3 |
Dementia and Alzheimer’s disease | 146 | 20.6 | 70 | 15.6 | 76 | 29.1 | 121 | 19.9 | 25 | 24.8 | 278 | 14.5 |
Pulmonary disease | 34 | 4.8 | 24 | 5.3 | 10 | 3.8 | 29 | 4.8 | 5 | 5.0 | 119 | 6.2 |
Pneumonia | 16 | 2.3 | 9 | 2.0 | 7 | 2.7 | 15 | 2.5 | 1 | 1.0 | 45 | 2.3 |
Trauma | 75 | 10.6 | 50 | 11.1 | 25 | 9.6 | 65 | 10.7 | 10 | 9.9 | 58 | 3.0 |
Accidental falls | 41 | 5.8 | 25 | 5.6 | 16 | 6.1 | 36 | 5.9 | 5 | 5.0 | 33 | 1.7 |
Subdural hematoma, traumatic | 38 | 5.4 | 25 | 5.6 | 13 | 5.0 | 33 | 5.4 | 5 | 5.0 | 9 | 0.5 |
Subdural hematoma, non-traumatic | 4 | 0.6 | 4 | 0.9 | 0 | 3 | 0.5 | 1 | 1.0 | 1 | 0.05 | |
Unknown | 0 | 0 | 0 | 0 | 0 | 20 | 1.0 |