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Development of the Subdural Hematoma in the Elderly (SHE) score to predict mortality.
Alford, Elizabeth N; Rotman, Lauren E; Erwood, Matthew S; Oster, Robert A; Davis, Matthew C; Pittman, H Bruce C; Zeiger, H Evan; Fisher, Winfield S.
Afiliación
  • Alford EN; 1Department of Neurosurgery.
  • Rotman LE; 1Department of Neurosurgery.
  • Erwood MS; 1Department of Neurosurgery.
  • Oster RA; 2Department of Medicine, Division of Preventive Medicine; and.
  • Davis MC; 1Department of Neurosurgery.
  • Pittman HBC; 1Department of Neurosurgery.
  • Zeiger HE; 3Department of Neurology, University of Alabama at Birmingham, Alabama.
  • Fisher WS; 1Department of Neurosurgery.
J Neurosurg ; 132(5): 1616-1622, 2019 Apr 12.
Article en En | MEDLINE | ID: mdl-30978691
ABSTRACT

OBJECTIVE:

The purpose of this study was to describe the development of a novel prognostic score, the Subdural Hematoma in the Elderly (SHE) score. The SHE score is intended to predict 30-day mortality in elderly patients (those > 65 years of age) with an acute, chronic, or mixed-density subdural hematoma (SDH) after minor, or no, prior trauma.

METHODS:

The authors used the Prognosis Research Strategy group methods to develop the clinical prediction model. The training data set included patients with acute, chronic, and mixed-density SDH. Based on multivariate analyses from a large data set, in addition to review of the extant literature, 3 components to the score were selected age, admission Glasgow Coma Scale (GCS) score, and SDH volume. Patients are given 1 point if they are over 80 years old, 1 point for an admission GCS score of 5-12, 2 points for an admission GCS score of 3-4, and 1 point for SDH volume > 50 ml. The sum of points across all categories determines the SHE score.

RESULTS:

The 30-day mortality rate steadily increased as the SHE score increased for all SDH acuities. For patients with an acute SDH, the 30-day mortality rate was 3.2% for SHE score of 0, and the rate increased to 13.1%, 32.7%, 95.7%, and 100% for SHE scores of 1, 2, 3, and 4, respectively. The model was most accurate for acute SDH (area under the curve [AUC] = 0.94), although it still performed well for chronic (AUC = 0.80) and mixed-density (AUC = 0.87) SDH.

CONCLUSIONS:

The SHE score is a simple clinical grading scale that accurately stratifies patients' risk of mortality based on age, admission GCS score, and SDH volume. Use of the SHE score could improve counseling of patients and their families, allow for standardization of clinical treatment protocols, and facilitate clinical research studies in SDH.
Palabras clave

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Guideline / Prognostic_studies / Risk_factors_studies Idioma: En Revista: J Neurosurg Año: 2019 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Guideline / Prognostic_studies / Risk_factors_studies Idioma: En Revista: J Neurosurg Año: 2019 Tipo del documento: Article
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