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Development of a prognostic scoring system to predict risk of reoperation for contralateral hematoma growth after unilateral evacuation of bilateral chronic subdural hematoma.
J Clin Neurosci. 2020 Aug; 78:79-85.JC

Abstract

Bilateral chronic subdural hematoma (bCSDH) is frequently drained unilaterally when the contralateral CSDH is small and asymptomatic. However, reoperation rates for contralateral CSDH growth can be high. We aimed to develop a prognostic scoring system to guide the selection of suitable patients for unilateral drainage of bCSDH. Data were collected retrospectively across three tertiary hospitals from 2010 to 2017 on all consecutive bCSDH patients aged 21 or above. Predictors of reoperation were identified using multivariable logistic regression. A prognostic score was developed and internally validated. 240 bCSDH patients were analyzed. 98 (40.8%) underwent unilateral and 142 (59.2%) underwent bilateral evacuation. Clinical outcomes were comparable between the unilateral and bilateral evacuation groups. Within the unilateral evacuation group, 4 (4.1%) had a reoperation for contralateral CSDH growth. Reoperation for contralateral CSDH was predicted by preoperative use of anticoagulants (OR = 15.0, 95% CI: 1.49-169.15, p = 0.017). Complete resolution of contralateral CSDH was predicted by its preoperative maximum width, with a cut-off of 9 mm producing the highest sensitivity and specificity (OR = 4.17 for ≤9 mm, 95% CI: 1.54-11.11, p = 0.004). Using our prognostic score, reoperation rate for contralateral CSDH was 1.6%, 3.6%, 16.7%, and 50.0% in low-risk, moderate-risk, high-risk and very high-risk patients, respectively. With each increase of 1 in the prognostic score, patients were 4 times as likely to undergo reoperation for contralateral CSDH (OR = 3.98, 95% CI: 1.36-13.53, p = 0.013). Our proposed risk score may be used as an adjunct in clinical decision making for bCSDH patients undergoing unilateral evacuation.

Authors+Show Affiliations

Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Level 11, Singapore 119228, Singapore. Electronic address: zhangjohnjy@gmail.com.Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Level 11, Singapore 119228, Singapore. Electronic address: e0012308@u.nus.edu.Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, 1E Kent Ridge Road, Level 11, Singapore 119228, Singapore. Electronic address: aaron_foo@nuhs.edu.sg.Department of Neurosurgery, Khoo Teck Puat Hospital, Alexandra Health Private Limited, National University Health System, 90 Yishun Central, Singapore 768828, Singapore. Electronic address: yang.ming@ktph.com.sg.Department of Neurosurgery, Khoo Teck Puat Hospital, Alexandra Health Private Limited, National University Health System, 90 Yishun Central, Singapore 768828, Singapore.Neurosurgery Service, Ng Teng Fong General Hospital, Jurong Health Campus, National University Health System, 1 Jurong East Street 21, Singapore 609606, Singapore. Electronic address: Ira_Sun@nuhs.edu.sg.Department of Neurosurgery, Khoo Teck Puat Hospital, Alexandra Health Private Limited, National University Health System, 90 Yishun Central, Singapore 768828, Singapore. Electronic address: ng.zhi.xu@ktph.com.sg.Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Level 11, Singapore 119228, Singapore; Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, 1E Kent Ridge Road, Level 11, Singapore 119228, Singapore. Electronic address: kejia_teo@nuhs.edu.sg.Department of Neurosurgery, Khoo Teck Puat Hospital, Alexandra Health Private Limited, National University Health System, 90 Yishun Central, Singapore 768828, Singapore. Electronic address: pang.boon.chuan@ktph.com.sg.Department of Neurosurgery, Khoo Teck Puat Hospital, Alexandra Health Private Limited, National University Health System, 90 Yishun Central, Singapore 768828, Singapore. Electronic address: yang.eugene.wr@ktph.com.sg.Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Level 11, Singapore 119228, Singapore; Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, 1E Kent Ridge Road, Level 11, Singapore 119228, Singapore. Electronic address: sein_lwin@nuhs.edu.sg.Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Level 11, Singapore 119228, Singapore; Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, 1E Kent Ridge Road, Level 11, Singapore 119228, Singapore. Electronic address: medcn@nus.edu.sg.Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Level 11, Singapore 119228, Singapore; Neurosurgery Service, Ng Teng Fong General Hospital, Jurong Health Campus, National University Health System, 1 Jurong East Street 21, Singapore 609606, Singapore. Electronic address: shiong_wen_low@nuhs.edu.sg.Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Level 11, Singapore 119228, Singapore; Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, 1E Kent Ridge Road, Level 11, Singapore 119228, Singapore.Department of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Hills Rd, Cambridge CB2 0QQ, United Kingdom. Electronic address: thomas.santarius@nhs.net.Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Level 11, Singapore 119228, Singapore; Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, 1E Kent Ridge Road, Level 11, Singapore 119228, Singapore. Electronic address: vincent_nga@nuhs.edu.sg.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32616352

Citation

Zhang, John J Y., et al. "Development of a Prognostic Scoring System to Predict Risk of Reoperation for Contralateral Hematoma Growth After Unilateral Evacuation of Bilateral Chronic Subdural Hematoma." Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia, vol. 78, 2020, pp. 79-85.
Zhang JJY, Wang S, Foo ASC, et al. Development of a prognostic scoring system to predict risk of reoperation for contralateral hematoma growth after unilateral evacuation of bilateral chronic subdural hematoma. J Clin Neurosci. 2020;78:79-85.
Zhang, J. J. Y., Wang, S., Foo, A. S. C., Yang, M., Quah, B. L., Sun, I. S., Ng, Z. X., Teo, K., Pang, B. C., Yang, E. W., Lwin, S., Chou, N., Low, S. W., Yeo, T. T., Santarius, T., & Nga, V. D. W. (2020). Development of a prognostic scoring system to predict risk of reoperation for contralateral hematoma growth after unilateral evacuation of bilateral chronic subdural hematoma. Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia, 78, 79-85. https://doi.org/10.1016/j.jocn.2020.06.009
Zhang JJY, et al. Development of a Prognostic Scoring System to Predict Risk of Reoperation for Contralateral Hematoma Growth After Unilateral Evacuation of Bilateral Chronic Subdural Hematoma. J Clin Neurosci. 2020;78:79-85. PubMed PMID: 32616352.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Development of a prognostic scoring system to predict risk of reoperation for contralateral hematoma growth after unilateral evacuation of bilateral chronic subdural hematoma. AU - Zhang,John J Y, AU - Wang,Shilin, AU - Foo,Aaron Song Chuan, AU - Yang,Ming, AU - Quah,Boon Leong, AU - Sun,Ira Siyang, AU - Ng,Zhi Xu, AU - Teo,Kejia, AU - Pang,Boon Chuan, AU - Yang,Eugene Weiren, AU - Lwin,Sein, AU - Chou,Ning, AU - Low,Shiong Wen, AU - Yeo,Tseng Tsai, AU - Santarius,Thomas, AU - Nga,Vincent Diong Weng, Y1 - 2020/06/30/ PY - 2020/04/02/received PY - 2020/05/30/revised PY - 2020/06/09/accepted PY - 2020/7/4/pubmed PY - 2020/7/4/medline PY - 2020/7/4/entrez KW - Bilateral KW - Chronic subdural hematoma KW - Prognostic KW - Reoperation KW - Risk KW - Score KW - Surgery SP - 79 EP - 85 JF - Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia JO - J Clin Neurosci VL - 78 N2 - Bilateral chronic subdural hematoma (bCSDH) is frequently drained unilaterally when the contralateral CSDH is small and asymptomatic. However, reoperation rates for contralateral CSDH growth can be high. We aimed to develop a prognostic scoring system to guide the selection of suitable patients for unilateral drainage of bCSDH. Data were collected retrospectively across three tertiary hospitals from 2010 to 2017 on all consecutive bCSDH patients aged 21 or above. Predictors of reoperation were identified using multivariable logistic regression. A prognostic score was developed and internally validated. 240 bCSDH patients were analyzed. 98 (40.8%) underwent unilateral and 142 (59.2%) underwent bilateral evacuation. Clinical outcomes were comparable between the unilateral and bilateral evacuation groups. Within the unilateral evacuation group, 4 (4.1%) had a reoperation for contralateral CSDH growth. Reoperation for contralateral CSDH was predicted by preoperative use of anticoagulants (OR = 15.0, 95% CI: 1.49-169.15, p = 0.017). Complete resolution of contralateral CSDH was predicted by its preoperative maximum width, with a cut-off of 9 mm producing the highest sensitivity and specificity (OR = 4.17 for ≤9 mm, 95% CI: 1.54-11.11, p = 0.004). Using our prognostic score, reoperation rate for contralateral CSDH was 1.6%, 3.6%, 16.7%, and 50.0% in low-risk, moderate-risk, high-risk and very high-risk patients, respectively. With each increase of 1 in the prognostic score, patients were 4 times as likely to undergo reoperation for contralateral CSDH (OR = 3.98, 95% CI: 1.36-13.53, p = 0.013). Our proposed risk score may be used as an adjunct in clinical decision making for bCSDH patients undergoing unilateral evacuation. SN - 1532-2653 UR - https://www.unboundmedicine.com/medline/citation/32616352/Development_of_a_prognostic_scoring_system_to_predict_risk_of_reoperation_for_contralateral_hematoma_growth_after_unilateral_evacuation_of_bilateral_chronic_subdural_hematoma L2 - https://linkinghub.elsevier.com/retrieve/pii/S0967-5868(20)31317-5 DB - PRIME DP - Unbound Medicine ER -
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