The Danish chronic subdural hematoma study-predicting recurrence of chronic subdural hematoma

Nina Christine Andersen-Ranberg, Birgit Debrabant, Frantz Rom Poulsen, Bo Bergholt, Torben Hundsholt, Kåre Fugleholm

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

BACKGROUND: An increasing incidence of chronic subdural hematoma (CSDH) and an unchanging high recurrence rate of 10-20% call for individualized treatment. The aim of this study was to establish individualized prediction models for the risk of recurrence treating death as a competing risk.

METHODS: A retrospective national cohort of unilateral CSDH was included for analysis. Using competing risk survival analysis, we tested whether available covariates were associated with the risk of recurrence. We further established a pre- and a postoperative prediction model, where predictors were chosen using a LASSO approach. The models were visualized in nomograms. Predictive performance was evaluated by c index and calibrations plots.

RESULTS: A total of 763 patients with surgically evacuated unilateral CSDH were included for analysis. The recurrence rate was 14% while 12% of patients died during follow-up (1 year). In our association model, hematoma size, drain type, drainage time, presence of complications, and Glasgow Coma Score were significantly associated to recurrence. Subdural drain was associated with a lower recurrence risk than subgaleal drain. The preoperative model included hematoma size, hematoma density, and history of hypertension. The postoperative model included further drain type, drainage time, and surgical complications.

CONCLUSION: The nomograms allow easy assessment of the recurrence risk for the individual patient, providing a better possibility for individual adjustment of treatment and follow-up. The predictive performance indicates that significant unaccounted or unknown factors still remain. The association test found passive subdural drain superior to passive subgaleal drain in minimizing the risk of CSDH recurrence.
OriginalsprogEngelsk
BogserieActa Neurochirurgica
Vol/bind161
Udgave nummer5
Sider (fra-til)885-894
ISSN0065-1419
DOI
StatusUdgivet - maj 2019

Fingeraftryk

Hematoma, Subdural, Chronic
Nomograms
Survival Analysis
Incidence

Emneord

  • Chronic subdural hematoma
  • Postoperative drain
  • Prediction model
  • Recurrence

Citer dette

Andersen-Ranberg, Nina Christine ; Debrabant, Birgit ; Poulsen, Frantz Rom ; Bergholt, Bo ; Hundsholt, Torben ; Fugleholm, Kåre. / The Danish chronic subdural hematoma study-predicting recurrence of chronic subdural hematoma. I: Acta Neurochirurgica. 2019 ; Bind 161, Nr. 5. s. 885-894.
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abstract = "BACKGROUND: An increasing incidence of chronic subdural hematoma (CSDH) and an unchanging high recurrence rate of 10-20{\%} call for individualized treatment. The aim of this study was to establish individualized prediction models for the risk of recurrence treating death as a competing risk.METHODS: A retrospective national cohort of unilateral CSDH was included for analysis. Using competing risk survival analysis, we tested whether available covariates were associated with the risk of recurrence. We further established a pre- and a postoperative prediction model, where predictors were chosen using a LASSO approach. The models were visualized in nomograms. Predictive performance was evaluated by c index and calibrations plots.RESULTS: A total of 763 patients with surgically evacuated unilateral CSDH were included for analysis. The recurrence rate was 14{\%} while 12{\%} of patients died during follow-up (1 year). In our association model, hematoma size, drain type, drainage time, presence of complications, and Glasgow Coma Score were significantly associated to recurrence. Subdural drain was associated with a lower recurrence risk than subgaleal drain. The preoperative model included hematoma size, hematoma density, and history of hypertension. The postoperative model included further drain type, drainage time, and surgical complications.CONCLUSION: The nomograms allow easy assessment of the recurrence risk for the individual patient, providing a better possibility for individual adjustment of treatment and follow-up. The predictive performance indicates that significant unaccounted or unknown factors still remain. The association test found passive subdural drain superior to passive subgaleal drain in minimizing the risk of CSDH recurrence.",
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The Danish chronic subdural hematoma study-predicting recurrence of chronic subdural hematoma. / Andersen-Ranberg, Nina Christine; Debrabant, Birgit; Poulsen, Frantz Rom; Bergholt, Bo; Hundsholt, Torben; Fugleholm, Kåre.

I: Acta Neurochirurgica, Bind 161, Nr. 5, 05.2019, s. 885-894.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - The Danish chronic subdural hematoma study-predicting recurrence of chronic subdural hematoma

AU - Andersen-Ranberg, Nina Christine

AU - Debrabant, Birgit

AU - Poulsen, Frantz Rom

AU - Bergholt, Bo

AU - Hundsholt, Torben

AU - Fugleholm, Kåre

PY - 2019/5

Y1 - 2019/5

N2 - BACKGROUND: An increasing incidence of chronic subdural hematoma (CSDH) and an unchanging high recurrence rate of 10-20% call for individualized treatment. The aim of this study was to establish individualized prediction models for the risk of recurrence treating death as a competing risk.METHODS: A retrospective national cohort of unilateral CSDH was included for analysis. Using competing risk survival analysis, we tested whether available covariates were associated with the risk of recurrence. We further established a pre- and a postoperative prediction model, where predictors were chosen using a LASSO approach. The models were visualized in nomograms. Predictive performance was evaluated by c index and calibrations plots.RESULTS: A total of 763 patients with surgically evacuated unilateral CSDH were included for analysis. The recurrence rate was 14% while 12% of patients died during follow-up (1 year). In our association model, hematoma size, drain type, drainage time, presence of complications, and Glasgow Coma Score were significantly associated to recurrence. Subdural drain was associated with a lower recurrence risk than subgaleal drain. The preoperative model included hematoma size, hematoma density, and history of hypertension. The postoperative model included further drain type, drainage time, and surgical complications.CONCLUSION: The nomograms allow easy assessment of the recurrence risk for the individual patient, providing a better possibility for individual adjustment of treatment and follow-up. The predictive performance indicates that significant unaccounted or unknown factors still remain. The association test found passive subdural drain superior to passive subgaleal drain in minimizing the risk of CSDH recurrence.

AB - BACKGROUND: An increasing incidence of chronic subdural hematoma (CSDH) and an unchanging high recurrence rate of 10-20% call for individualized treatment. The aim of this study was to establish individualized prediction models for the risk of recurrence treating death as a competing risk.METHODS: A retrospective national cohort of unilateral CSDH was included for analysis. Using competing risk survival analysis, we tested whether available covariates were associated with the risk of recurrence. We further established a pre- and a postoperative prediction model, where predictors were chosen using a LASSO approach. The models were visualized in nomograms. Predictive performance was evaluated by c index and calibrations plots.RESULTS: A total of 763 patients with surgically evacuated unilateral CSDH were included for analysis. The recurrence rate was 14% while 12% of patients died during follow-up (1 year). In our association model, hematoma size, drain type, drainage time, presence of complications, and Glasgow Coma Score were significantly associated to recurrence. Subdural drain was associated with a lower recurrence risk than subgaleal drain. The preoperative model included hematoma size, hematoma density, and history of hypertension. The postoperative model included further drain type, drainage time, and surgical complications.CONCLUSION: The nomograms allow easy assessment of the recurrence risk for the individual patient, providing a better possibility for individual adjustment of treatment and follow-up. The predictive performance indicates that significant unaccounted or unknown factors still remain. The association test found passive subdural drain superior to passive subgaleal drain in minimizing the risk of CSDH recurrence.

KW - Chronic subdural hematoma

KW - Postoperative drain

KW - Prediction model

KW - Recurrence

KW - Chronic subdural hematoma

KW - Postoperative drain

KW - Prediction model

KW - Recurrence

U2 - 10.1007/s00701-019-03858-9

DO - 10.1007/s00701-019-03858-9

M3 - Journal article

VL - 161

SP - 885

EP - 894

JO - Acta Neurochirurgica Supplement

JF - Acta Neurochirurgica Supplement

SN - 0065-1419

IS - 5

ER -