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.
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.
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.
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.
ABBREVIATIONSAUC = area under the curve; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; NN = neural network; PROGRESS = Prognosis Research Strategy; SDH = subdural hematoma; SHE = Subdural Hematoma in the Elderly.
BalserDFarooqSMehmoodTReyesMSamadaniU: Actual and projected incidence rates for chronic subdural hematomas in United States Veterans Administration and civilian populations. J Neurosurg123:1209–12152015
BrennanPMKoliasAGJoannidesAJShapeyJMarcusHJGregsonBA: The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom. J Neurosurg127:732–7392017
MotoieRKarashimaSOtsujiRRenNNagaokaSMaedaK: Recurrence in 787 patients with chronic subdural hematoma: retrospective cohort investigation of associated factors including direct oral anticoagulant use. World Neurosurg118:e87–e912018
OkanoAOyaSFujisawaNTsuchiyaTIndoMNakamuraT: Analysis of risk factors for chronic subdural haematoma recurrence after burr hole surgery: optimal management of patients on antiplatelet therapy. Br J Neurosurg28:204–2082014
OrlandoALevyASRubinBATannerACarrickMMLieserM: Isolated subdural hematomas in mild traumatic brain injury. Part 1: the association between radiographic characteristics and neurosurgical intervention. J Neurosurg[epub ahead of print June 15 2018; DOI: 10.3171/2018.1.JNS171884]
OshiroEMWalterKAPiantadosiSWithamTFTamargoRJ: A new subarachnoid hemorrhage grading system based on the Glasgow Coma Scale: a comparison with the Hunt and Hess and World Federation of Neurological Surgeons Scales in a clinical series. Neurosurgery41:140–1481997
ThombreA: Comparing logistic regression, neural networks, c5.0 and M5ʹ classification techniques in PernerP (ed): Proceedings of the 8th International Conference on Machine Learning and Data Mining in Pattern Recognition. Berlin: Springer2012 Vol 7376 pp 132–140
United Nations Population Fund: Ageing in the Twenty-First Century: A Celebration and a Challenge. New York: UNFPA2012(https://www.unfpa.org/publications/ageing-twenty-first-century) [Accessed January 31 2019]