Incidence of chronic subdural haematoma: a single-centre exploration of the effects of an ageing population with a review of the literature.
Chronic subdural haematoma
Epidemiology
Health service planning
Incidence
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
09 2021
09 2021
Historique:
received:
08
04
2021
accepted:
13
05
2021
pubmed:
29
6
2021
medline:
25
11
2021
entrez:
28
6
2021
Statut:
ppublish
Résumé
Chronic subdural haematoma (cSDH) is a common neurosurgical pathology frequently occurring in older patients. The impact of population ageing on cSDH caseload has not been examined, despite relevance for health system planning. This is a single-centre study from the UK. Operated cases of cSDH (n = 446) for 2015-2018 were identified. Crude and directly standardised incidence rates were calculated. Medline and EMBASE were systematically searched to identify studies reporting on the incidence of cSDH by year, so an estimate of rate of incidence change could be determined. Local incidence rates were then applied to population projections for local catchment area to estimate operated cSDH numbers at 5 yearly intervals due to shifting demographics. We identified nine studies presenting incidence estimates. Crude estimates for operative cases ranged from 1.3/100,000/year (1.4-2.2) to 5.3/100,000/year (4.3-6.6). When non-operated cases were included, incidence was higher: 8.2/100,000/year (6.0-11.2) to 48/100,000/year (37.7-61.1). Four pairs of studies demonstrated incidence rate increases of 200-600% over the last 50 years, but data was deemed too heterogeneous to generate formal estimate of incidence change. Local crude incidence of operated cSDH was 3.50/100,000/year (3.19-3.85). Directly standardised incidence was 1.58/100,000/year (1.26-1.90). After applying local incidence rates to population projections, case numbers were predicted to increase by 53% over the next 20 years. The incidence of cSDH is increasing. We project a 53% increase in operative caseload within our region by 2040. These are important findings for guiding future healthcare planning.
Sections du résumé
BACKGROUND
Chronic subdural haematoma (cSDH) is a common neurosurgical pathology frequently occurring in older patients. The impact of population ageing on cSDH caseload has not been examined, despite relevance for health system planning.
METHODS
This is a single-centre study from the UK. Operated cases of cSDH (n = 446) for 2015-2018 were identified. Crude and directly standardised incidence rates were calculated. Medline and EMBASE were systematically searched to identify studies reporting on the incidence of cSDH by year, so an estimate of rate of incidence change could be determined. Local incidence rates were then applied to population projections for local catchment area to estimate operated cSDH numbers at 5 yearly intervals due to shifting demographics.
RESULTS
We identified nine studies presenting incidence estimates. Crude estimates for operative cases ranged from 1.3/100,000/year (1.4-2.2) to 5.3/100,000/year (4.3-6.6). When non-operated cases were included, incidence was higher: 8.2/100,000/year (6.0-11.2) to 48/100,000/year (37.7-61.1). Four pairs of studies demonstrated incidence rate increases of 200-600% over the last 50 years, but data was deemed too heterogeneous to generate formal estimate of incidence change. Local crude incidence of operated cSDH was 3.50/100,000/year (3.19-3.85). Directly standardised incidence was 1.58/100,000/year (1.26-1.90). After applying local incidence rates to population projections, case numbers were predicted to increase by 53% over the next 20 years.
CONCLUSIONS
The incidence of cSDH is increasing. We project a 53% increase in operative caseload within our region by 2040. These are important findings for guiding future healthcare planning.
Identifiants
pubmed: 34181085
doi: 10.1007/s00701-021-04879-z
pii: 10.1007/s00701-021-04879-z
pmc: PMC8357776
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
2629-2637Subventions
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 204017/Z/16/Z
Pays : United Kingdom
Organisme : Department of Health
Pays : United Kingdom
Informations de copyright
© 2021. The Author(s).
Références
Adhiyaman V, Asghar M, Ganeshram KN, Bhowmick BK (2002) Chronic subdural haematoma in the elderly. Postgrad Med J 78(916):71–75
doi: 10.1136/pmj.78.916.71
Adhiyaman V, Chattopadhyay I, Irshad F, Curran D, Abraham S (2017) Increasing incidence of chronic subdural haematoma in the elderly. QJM-AN Int J Med 110(6):375–378
Alfirevic A, Downing J, Daras K, Comerford T, Pirmohamed M, Barr B (2020) Has the introduction of direct oral anticoagulants (DOACs) in England increased emergency admissions for bleeding conditions? BMJ Open 10:33357
doi: 10.1136/bmjopen-2019-033357
Asghar M, Adhiyaman V, Greenway MW, Bhowmick BK, Bates A (2002) Chronic subdural haematoma in the elderly - a North Wales experience. J R Soc Med 95(6):290–292
pubmed: 12042376
pmcid: 1279911
Baiser D, Farooq S, Mehmood T, Reyes M, Samadani U (2015) Actual and projected incidence rates for chronic subdural hematomas in United States Veterans Administration and civilian populations. J Neurosurg 123(5):1209–1215
doi: 10.3171/2014.9.JNS141550
Bartek JJ, Sjavik K, Stahl F, Kristiansson H, Solheim O, Gulati S, Sagberg LM, For EP, Jakola AS (2017) Surgery for chronic subdural hematoma in nonagenarians: a Scandinavian population-based multicenter study. Acta Neurol Scand 136(5):516–520
doi: 10.1111/ane.12764
Brennan PM, Kolias AG, Joannides AJ, Shapey J, Marcus HJ, Gregson BA, Grover PJ, Hutchinson PJ, Coulter IC (2016) The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom. J Neurosurg 127(4):732–739
doi: 10.3171/2016.8.JNS16134
Chelvarajah R, Lee JK, Chandrasekaran S, Bavetta S (2007) A clinical audit of neurosurgical bed usage. Br J Neurosurg 21(6):610–613
doi: 10.1080/02688690701649488
Edlmann E, Giorgi-Coll S, Whitfield PC, Carpenter KLH, Hutchinson PJ (2017) Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation 14(1):1–13
doi: 10.1186/s12974-017-0881-y
Fogelholm R, Waltimo O (1975) Epidemiology of chronic subdural haematoma. Acta Neurochir (Wien) 32(3):247–250
doi: 10.1007/BF01405457
Gaist D, Garcia Rodriguez LA, Hellfritzsch M, Poulsen FR, Halle B, Hallas J, Pottegard A (2017) Association of antithrombotic drug use with subdural hematoma risk. JAMA - J Am Med Assoc 317(8):836–846
doi: 10.1001/jama.2017.0639
Harper S, Walport M, Banks J, Boyle P, Kirwood T, M. K, Myerson J, Sinfield M, Walker A, Wells O (2016) Future of an aging population. Gov Off Sci - Foresight Rep 1–124
Kudo H, Kuwamura K, Izawa I, Sawa H, Tamaki N (1992) Chronic subdural hematoma in elderly people: present status on Awaji Island and epidemiological prospect. Neurol Med Chir (Tokyo) 32(4):207–209
doi: 10.2176/nmc.32.207
Magalhães MJ da S de, Araújo JP, Paulino ALASA, Batista BHM, Freitas DG de, Santos JD da C, Andrade NL de P (2019) Epidemiology and estimated cost of surgery for chronic subdural hematoma conducted by the unified health system in Brazil (2008–2016). Arq Bras Neurocir Brazilian Neurosurg 38(02):079–085
Mellergard P, Wisten O (1996) Operations and re-operations for chronic subdural haematomas during a 25-year period in a well defined population. Acta Neurochir (Wien) 138(6):708–713
doi: 10.1007/BF01411476
Neifert SN, Chaman EK, Hardigan T, Ladner TR, Feng R, Caridi JM, Kellner CP, Oermann EK (2020) Increases in subdural hematoma with an aging population—the future of American cerebrovascular disease. World Neurosurg. Elsevier Inc., pp e166–e174
Office for National Statistics (2012) 2011 Census - population and household estimates for England and Wales. 1–36
Peters ME (2016) Traumatic brain injury (TBI) in older adults: aging with a TBI versus incident TBI in the aged. Int Psychogeriatrics 28(12):1931–1934
doi: 10.1017/S1041610216001666
Poulsen FR, Halle B, Pottegard A, Garcia Rodriguez LA, Hallas J, Gaist D (2016) Subdural hematoma cases identified through a Danish patient register: diagnosis validity, clinical characteristics, and preadmission antithrombotic drug use. Pharmacoepidemiol Drug Saf 25(11):1253–1262
doi: 10.1002/pds.4058
R Core Team (2013) R: A language and environment for statistical computing
Rauhala M, Luoto TM, Huhtala H, Iverson GL, Niskakangas T, Öhman J, Helén P (2020) The incidence of chronic subdural hematomas from 1990 to 2015 in a defined Finnish population. J Neurosurg 132(4):1147–1157
doi: 10.3171/2018.12.JNS183035
Rust T, Kiemer N, Erasmus A (2006) Chronic subdural haematomas and anticoagulation or anti-thrombotic therapy. J Clin Neurosci 13(8):823–827
doi: 10.1016/j.jocn.2004.12.013
Statistics O for N (2019) Population projections for clinical commissioning groups and NHS regions. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationprojections/datasets/clinicalcommissioninggroupsinenglandz2 . Accessed 20 May 2019
Stubbs DJ, Davies BM, Bashford T, Joannides AJ, Hutchinson PJ, Menon DK, Ercole A, Burnstein RM (2020) Identification of factors associated with morbidity and postoperative length of stay in surgically managed chronic subdural haematoma using electronic health records: a retrospective cohort study. BMJ Open 10(6):e037385
Teo DB, Wong HC, Yeo AW, Lai YW, Choo EL, Merchant RA (2018) Characteristics of fall-related traumatic brain injury in older adults. Intern Med J 48(9):1048–1055
doi: 10.1111/imj.13794
Whitehouse KJ, Jeyaretna DS, Wright A, Whitfield PC (2016) Neurosurgical care in the elderly: increasing demands necessitate future healthcare planning. World Neurosurg 87:446–454
doi: 10.1016/j.wneu.2015.10.099
World Health Organisation World (WHO 2000–2025) Standard population. https://seer.cancer.gov/stdpopulations/world.who.html . Accessed 17 Jun 2019
Yang W, Huang J (2017) Chronic subdural hematoma: epidemiology and natural history. Neurosurg Clin N Am 28(2):205–210
doi: 10.1016/j.nec.2016.11.002