1 Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere;
2 Faculty of Social Sciences, Biostatistics Group, Tampere University, Tampere, Finland;
3 Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts; and
4 Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland
The aim of this study was to determine the population-based epidemiology of chronic subdural hematoma (CSDH) over a 26-year period.
A retrospective study was conducted of all adult patients (≥ 18 years and residents of Pirkanmaa [Finland]) with a diagnosis of CSDH between 1990 and 2015. The cases were identified using ICD codes. Detailed data collection was performed using medical records and death certificates. All patients were monitored until death or the end of year 2017. The annual number of inhabitants in the Pirkanmaa region was obtained from Statistics Finland (Helsinki, Finland).
A total of 1168 patients with CSDH were identified from hospital records and death certificates; patients were considered as new-incidence cases if 2 years had elapsed following primary treatment and in cases involving a new contralateral CSDH. From 1990 to 2015, the overall incidence of CSDH doubled from 8.2 to 17.6/100,000/year. Among adults younger than 70 years, the incidence remained quite stable, whereas the incidence clearly increased among the ≥ 80-year-old population, from 46.9 to 129.5/100,000/year. The median age for a CSDH diagnosis increased from 73 to 79 years during the 26-year period. Head trauma was documented in 59% of cases. A ground-level fall was related to the CSDH in 31% of patients younger than 60 years and in 54% of those 80 years or older. The proportion of alcohol-related cases decreased toward the end of the study period (1990–1995: 16% and 2011–2015: 7%), because alcohol abuse was less frequent among the growing group of elderly patients. In contrast, the percentage of patients receiving anticoagulant or antiplatelet medication almost doubled toward 2015 (1990–1995, 27%; and 2011–2015, 49%). The patients’ neurological condition on admission, based on both Glasgow Coma Scale score (score < 13: 1990–1995, 18%; and 2011–2015, 7%; p < 0.001) and the modified Rankin Scale score (score 0–2: 1990–1995, 8%; and 2011–2015, 19%; p < 0.001), was better in recent years than in the early 1990s.
From 1990 to 2015, the incidence of CSDH has increased markedly. The incidence of CSDH among the population 80 years or older has nearly tripled since 1990. The use of anticoagulants has increased, but there has been no change regarding the ratio between a traumatic and a spontaneous CSDH etiology. As the world population becomes progressively older, the increasing incidence of CSDH will be a burden to patients and a future challenge for neurosurgical clinics.
Correspondence Minna Rauhala: Tampere University Hospital and Tampere University, Tampere, Finland. firstname.lastname@example.org.
INCLUDE WHEN CITING Published online March 22, 2019; DOI: 10.3171/2018.12.JNS183035.
Disclosures Dr. Luoto has received funding from the Government’s Special Financial Transfer tied to academic research in Health Sciences (Finland), the Emil Aaltonen Foundation, and Finnish Medical Society Duodecim. Dr. Iverson acknowledges unrestricted philanthropic support from the Mooney-Reed Charitable Foundation, Heinz Family Foundation, and ImPACT Applications, Inc. He serves as a strategic scientific advisor for BioDirection, Inc.
BalserDFarooqSMehmoodTReyesMSamadaniU: Actual and projected incidence rates for chronic subdural hematomas in United States Veterans Administration and civilian populations. J Neurosurg123:1209–12152015
BergerJSRoncaglioniMCAvanziniFPangrazziITognoniGBrownDL: Aspirin for the primary prevention of cardiovascular events in women and men: a sex-specific meta-analysis of randomized controlled trials. JAMA295:306–3132006
BorgerVVatterHOszvaldÁMarquardtGSeifertVGüresirE: Chronic subdural haematoma in elderly patients: a retrospective analysis of 322 patients between the ages of 65–94 years. Acta Neurochir (Wien)154:1549–15542012
LaupacisABoysenGConnollySEzekowitzMHartRJamesK: Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized controlled trials. Arch Intern Med154:1449–14571994
National Institute for Health and Welfare: Official Statistics of Finland (OSF): Alcoholic Beverage Consumption. Helsinki: National Institute for Health and Welfare(http://www.stat.fi/til/ajkul/index_en.html) [Accessed January 17 2018]
PalvanenMKannusPPiirtolaMNiemiSParkkariJJärvinenM: Effectiveness of the Chaos Falls Clinic in preventing falls and injuries of home-dwelling older adults: a randomised controlled trial. Injury45:265–2712014