高齢者慢性硬膜下血腫の転帰不良因子についての検討

抄録

Objective: The authors report the incidence and prognostic factors of poor outcome in patients over 65 years old with chronic subdural hematoma (CSDH).

Method: We retrospectively analyzed 695 CSDH patients who had been operated on at our hospital between 1976 and 2003.

Results: Among them, 395 patients (56.8%) were older than 65 years, and 222 patients (31.9%) were older than 75 years. The number of patients with CSDH in the elderly has increased rapidly year by year. In 1975, there were 2.7 per year. In contrast, in 2000, it was 27 per year, i.e, 10 times higher. A total of 301 of the 395 patients (76.2%) had a favorite outcome (GOS = GR, MD), and 72 patients (18.2%) had a poor outcome (GOS = MD, SD) with persistence of walking disturbance on leaving the hospital. Eleven patients (1.6%) died, nine patients due to general complications and 1 patient from surgical complications. In the present study, prognostic factors of poor outcome were moderate consciousness disturbance (GCS≦13) (p<0.001) and being bedridden for more than 4 days before admission to hospital (p<0.001).

Conclusions: We demonstrated that consciousness and pro-hospital clinical level had a significant influence on outcome in elderly patients with CSDH.