Prognosis of acute subdural haematoma from intracranial aneurysm rupture
- 1Utrecht Stroke Centre, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Centre, Utrecht, The Netherlands
- 2Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
- Correspondence to Dr J M Biesbroek, University Medical Centre Utrecht, Utrecht Stroke Centre, Department of Neurology and Neurosurgery, Heidelberglaan 100, Room G03.323, Utrecht 3508 GA, The Netherlands;
- Received 28 December 2011
- Revised 3 September 2012
- Accepted 25 September 2012
- Published Online First 31 October 2012
Background Acute subdural haematoma (aSDH) is a rare complication of aneurysmal subarachnoid haemorrhage (SAH) and is associated with poor clinical condition on admission and poor outcome.
Objective The aim of this study was to assess whether aneurysmal aSDH is an independent risk factor for poor outcome.
Methods In a series of 1632 patients retrieved from our prospectively collected single centre SAH database and fulfilling prespecified inclusion criteria, we found 53 patients with aSDH on the initial CT scan. From the same series, we collected 660 patients in whom aSDH was ruled out by reviewing the initial CT scan. We compared the risk of poor outcome at discharge and at 3 months between patients with and without aSDH by calculating crude risk ratios (RRs) with corresponding 95% CIs, and adjusting for age, sex, location and treatment modality of the aneurysm that bled, clinical condition on admission, intracerebral haemorrhage, intraventricular haemorrhage and hydrocephalus, with Poisson regression.
Results Patients with aSDH had a higher risk of poor outcome at discharge (crude RR 1.59; 95% CI 1.35 to 1.86) and at 3 months (crude RR: 2.17, 95% CI 1.79 to 2.62) than patients without aSDH. After simultaneous adjustment for five characteristics that affected the crude RR, the RR for poor outcome for patients with aSDH at discharge was 1.15 (95% CI 0.97 to 1.37) and at 3 months 1.30 (95% CI 1.04 to 1.62).
Conclusions The presence of aSDH in patients with aneurysmal SAH is an independent risk factor for poor outcome at 3 months.