Chronic subdural haematoma (cSDH) is a common pathology and recurrence is a common complication, which may be predicted by certain radiological and patient factors. Empiric radiological surveillance has been shown to convey no benefit.
A retrospective review of a prospectively collated database was performed. Pre- and post-operative non-contrast computed tomography (NCCT) scans were reviewed. Radiological appearance, pre-operative haematoma volume, patient age, presence of bilateral haematomas, maximal haematoma thickness and therapeutic coagulopathy were assessed as predictors. Receiver operating curve (ROC) analysis, logistic regression and LASSO regression were used to select potential predictors. A multivariate model was then fitted and a score derived.
142 patients were included. Maximal thickness >12mm (p = 0.02) and age >65 years (p = 0.01) were found to correlate with likelihood of recurrence. Bilateral haematomas and a hyperdense or mixed density appearance were additionally identified on LASSO regression. Bilateral haematomas (p = 0.19), hyperdense or mixed density (p = 0.66), max thickness >12mm (p = 0.01) and age >65 (p = 0.02) were included in the multivariate model. A 6-point score was derived. A score of >3 had a sensitivity of 89% (95%CI 78-97) and specificity of 26% (95%CI 17-34) for predicting recurrence, with recurrence significantly more likely in patients with a score of 4-6 versus 0-3 (p = 0.02).
Certain radiological findings may predict recurrence of cSDH following evacuation. The score derived may be useful in deciding the patient who might benefit from routine post-operative surveillance radiological imaging.
Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.
Derivation of a clinical score for prediction of recurrence following evacuation of chronic subdural haematoma: A retrospective cohort study at a national referral centre.
