Acute subdural haematoma in the elderly: to operate or not to operate? A systematic review and meta-analysis of outcomes following surgery
| العنوان: | Acute subdural haematoma in the elderly: to operate or not to operate? A systematic review and meta-analysis of outcomes following surgery |
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| المؤلفون: | Malik Zaben, Susruta Manivannan, O Marei, Isaac Mayo, Robert Spencer, Omar Elalfy, John Martin |
| المصدر: | BMJ Open, Vol 11, Iss 12 (2021) BMJ Open |
| بيانات النشر: | BMJ Publishing Group, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | medicine.medical_specialty, Pediatrics, Traumatic brain injury, medicine.medical_treatment, Subdural haematoma, Glasgow Outcome Scale, Risk Factors, Brain Injuries, Traumatic, medicine, Hematoma, Subdural, Acute, Humans, neurosurgery, Craniotomy, Aged, Retrospective Studies, Geriatrics, business.industry, geriatric medicine, General Medicine, Middle Aged, medicine.disease, Treatment Outcome, Meta-analysis, trauma management, Medicine, Decompressive craniectomy, Surgery, Neurosurgery, business |
| الوصف: | ObjectivesAcute subdural haematoma (ASDH) is a devastating pathology commonly found on CT brain scans of patients with traumatic brain injury. The role of surgical intervention in the elderly has been increasingly questioned due to its associated morbidity and mortality. Therefore, a systematic review and meta-analysis of the literature to quantify the mortality and functional outcomes associated with surgical management of ASDH in the elderly was performed.Design/settingA multidatabase literature search between January 1990 and May 2020, and meta-analysis of proportions was performed to quantify mortality and unfavourable outcome (Glasgow Outcome scale 1–3; death/ severe disability) rates.ParticipantsStudies reporting patients aged 60 years or older.InterventionsCraniotomy, decompressive craniectomy, conservative management.Outcome measuresMortality and functional outcomes (discharge, long-term follow-up (LTFU)).Results2572 articles were screened, yielding 21 studies for final inclusion and 15 for meta-analysis. Pooled estimates of mortality were 39.83% (95% CI 32.73% to 47.14%; 10 studies, 308/739 patients, I2=73%) at discharge and 49.30% (95% CI 42.01% to 56.61%; 10 studies, 277/555 patients, I2=63%) at LTFU. Mean duration of follow-up was 7.1 months (range 2–12 months). Pooled estimate of percentage of poor outcomes was 81.18% (95% CI 75.61% to 86.21%; 6 studies, 363/451 patients, I2=45%) at discharge, and 79.25% (95% CI 72.42% to 85.37%; 8 studies, 402/511 patients, I2=66%) at LTFU. Mean duration of follow-up was 6.4 months (range 2–12 months). Potential risk factors for poor outcome included age, baseline functional status, preoperative neurological status and imaging parameters.ConclusionsOutcomes following surgical evacuation of ASDH in patients aged 60 years and above are poor. This constitutes the best level of evidence in the current literature that surgical intervention for ASDH in the elderly carries significant risks, which must be weighed against benefits.PROSPERO registration numberCRD42020189508. |
| وصف الملف: | application/pdf |
| اللغة: | English |
| تدمد: | 2044-6055 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5e37fc218222639c4af1448fe9bcd606 https://bmjopen.bmj.com/content/11/12/e050786.full |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....5e37fc218222639c4af1448fe9bcd606 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 20446055 |
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