Acute subdural hematomas in nonagenarians and centenarians

Background: There is minimal literature on the outcomes of acute traumatic subdural hematoma (SDH) in patients 90 years of age or older. This study aims to characterize the presentation and acute outcomes of patients in this population, particularly for surgical candidates.

Methods: Patients 90 years of age or older with acute SDH between 2013-2023 were analyzed (n = 117). Multivariable binomial logistic regression assessed associations with favorable outcome, defined as a discharge to a non-hospice facility with a Glasgow Coma Scale (GCS) of 14 or greater. Nominal data was analyzed via Wilcoxon rank-sum test and categorical data was analyzed via Chi-squared test.

Results: For this patient population mortality was 7.7%. 86.3% of all patients had favorable outcome.Eight patients underwent surgery, with two resulting in mortality.. However, 62.5% of patients who underwent surgery had a favorable outcome. Patients undergoing surgery had longer average length of stay (P = 0.002), greater in-hospital mortality (P = 0.013), and younger age (P = 0.008) compared to non-surgical patients. Prior independence (OR 7.07, 95% CI 1.33-37.45, P = 0.022) and higher GCS at arrival (OR 1.67, 95% CI 1.11-2.49, P = 0.013) were associated with favorable outcomes.

Conclusion: 86.3% of patients 90 years of age or older with acute subdural hematomas had a favorable outcome in our series. Prior independence and higher GCS at arrival were associated with favorable discharge. Several patients had good outcomes after craniotomy for acute SDH, indicating there are some patients in this age group who should be considered for surgery.