A prognostic scoring system for contralateral hematoma progression of bilateral chronic subdural hematomas after initial unilateral evacuation and preliminary assessment of its effectiveness / 中华神经医学杂志

ABSTRACT

Objective To investigate the risk factors for contralateral hematoma progression of bilateral chronic subdural hematomas (bCSDHs) after initial unilateral evacuation,and finally develop a prognostic scoring system.Methods Sixty-one patients with bCSDHs underwent initial unilateral evacuation in our hospital from October 2012 to March 2019 were chosen in our study.During follow up,CT examination was used to determine whether the patients had developed eontralateral hematoma.The clinical data of patients from the progressive group and non-progressive group were retrospectively analyzed and compared.Multivariate Logistic regression was used to analyze the independent risk factors for postoperative contralateral hematoma progression.Receiver operating characteristic (ROC) curve was established to predict the progression of contralateral hematoma for each risk factor.A prognostic grading system was developed on the basis of independent risk factors and cut-off value.All patients were scored according to the scoring system and the progression rate of different scores were re-analyzed.Results As compared with the non-progressive group,the progressive group had higher proportions of patients with extensive contralateral hematoma distribution or low density of contralateral hematoma,higher amount of preoperative contralateral hematoma and postoperative hematoma,with statistically significant differences (P＜0.05).Multivariate Logistic regression analysis showed that extensive contralateralhematomadistribution (OR=16.726,95％CI:2.034-137.557,P=0.009),and hematoma volume after contralateral hematoma surgery (OR=1.044,95％CI:1.012-1.078,P=0.007) were independent risk factors for contralateral hematoma progression.ROC curve showed that areas under the curve for contralateral hematoma distribution and hematoma volume after contralateral hematoma surgery were 0.682 and 0.737,respectively.Limited type of contralateral hematoma was set as 0 score,and extensive type was set as one score;hematoma volume after contralateral hematoma surgery＞40 cm3 was set as one score,and that≤40 cm3 was set as 0 score.All patients were scored,and the scoring system was ranged from 0 to 2 scores;the contralateral hematoma progression rate of 0,1,and 2 were 0％,23.81％,and57.69％,respectively,with significantdifferences (P＜0.05).Conclusion Extensive contralateral hematoma distribution and hematoma volume after contralateral hematoma surgery are independent risk factors for contralateral hematoma progression of bCSDHs after initial unilateral evacuation;the prognostic scoring system is simple and practical,which can serve as part of clinical references.