Surgical evacuation of acute subdural hematoma in octogenarians: a ten-year experience from a single trauma center

Background: Elderly patients presenting with an acute subdural hematoma (aSDH) have historically had unfavorable outcomes. Methods: We retrospectively reviewed patient records from 2005 through 2015 that were >= 80 years of age and underwent surgical evacuation of aSDH. Results: Thirty-four patients met inclusion criteria, with a mean age of 84 years (range 80-91). Glascow Outcome Scale (GOS) of 4-5 was deemed a good outcome and a GOS 1-3 was deemed to be a poor outcome. Six patients had good outcome at last follow up and 27 patients had poor outcome. Patients with a higher presenting Glascow Coma Scale (GCS) trended towards better outcome [(good: mean 13.1, median 14.5, IQR 12.5-15) vs. (poor: mean 9.6, median 10, IQR 6-14) p = 0.06]. Patients with a higher in-hospital post-operative GCS score had significantly better overall outcome than patients who left the hospital with a lower GCS score [(good: mean 14.5, median 14.5, IQR 14-15) vs. (poor: mean 8.4, median 9, IQR 4-11) p = 0.001]. Patients with a good outcome had a median aSDH thickness of 17mm (IQR 12.75-19.75) while patients with a poor outcome had a median thickness of 20 mm (IQR 16-24.5); p = 0.17. In addition, patients with a good outcome had a median midline shift of 10 mm (IQR 6-12.5), while patients with a poor outcome had a median midline shift of 14 mm (IQR 10-20); p = 0.07. Conclusions: The prognosis for elderly patients with large aSDH remains poor, but a subset of patients can benefit from surgical intervention.