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The Danish Chronic Subdural Hematoma Study—comparison of hematoma age to the radiological appearance at time of diagnosis

  • Original Article - Brain trauma
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Abstract

Introduction

Chronic subdural hematomas (CSDH) show different radiological characteristics on CT scans at the time of diagnosis. The reason for this is largely unknown. We hypothesize that the imaging characteristics reflect a time-linked pathophysiological evolution. We therefore conducted a retrospective study to examine a possible relation between the hematoma age and the radiological subtype of a CSDH.

Methods

Demographic data on patients with CSDH were retrieved from a Danish national cohort from 2010 to 2012. CT scans obtained on admission to a neurosurgical department were categorized as homogenous, separated, mixed, or membranous hematoma subtypes. The time from a known date of head injury to time of diagnostic CT was defined as hematoma age. The hematoma age was correlated to radiological hematoma subtype at the time of diagnosis by analysis of variance testing.

Results

In total, 543 patients were analyzed for hematoma age and classified in the following hematoma subtypes: 231 homogenous, 44 separated, 119 mixed, and 149 membranous. Patients with homogenous, separated, mixed, and membranous hematoma subtypes had a median interval of 37, 36, 40, and 60 days from head injury to diagnostic CT. We found that membranous hematoma is significantly older than other subtypes. Comparison between the other radiological subtypes showed no statistical hematoma age difference. The distribution of radiological subtypes in 590 patients without a known head injury was similar to that of patients with a known head injury. Additionally, we found that hematoma age was significantly younger for patients on antiplatelet medication.

Conclusion

In this large national cohort, patients with membranous CSDH had a significantly longer interval between head injury and diagnosis compared to other radiological subtypes. This indicates that the radiological appearance of CSDH evolves over time, causing an alteration from different early radiological subtypes to a radiological subtype with membranes.

Clinical trial registration number

The study was approved by the Danish Data Protection Agency (journal no.30-1145).

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Author notes

  1. Thorbjørn Søren Rønn Jensen and Nina Andersen-Ranberg contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Rigshospitalet, 2092, Blegdamsvej 9, 2100, Copenhagen Ø, DK, Denmark

    Thorbjørn Søren Rønn Jensen, Nina Andersen-Ranberg & Kåre Fugleholm

  2. Department of Neurosurgery, University Hospital Odense, Odense, Denmark

    Frantz Rom Poulsen

  3. Department of Neurosurgery, University Hospital Aarhus, Aarhus, Denmark

    Bo Bergholt

  4. Department of Neurosurgery, University Hospital Aalborg, Aalborg, Denmark

    Torben Hundsholt

Authors
  1. Thorbjørn Søren Rønn Jensen
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  2. Nina Andersen-Ranberg
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  3. Frantz Rom Poulsen
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  4. Bo Bergholt
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  5. Torben Hundsholt
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  6. Kåre Fugleholm
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Corresponding author

Correspondence to Thorbjørn Søren Rønn Jensen.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the national research committee (Danish Data Protection Agency) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed consent

The research has not been and will not be submitted simultaneously to another journal nor presented at a conference, in whole or in part. The paper reports previously unpublished work. All those named as authors have made a sufficient contribution to the work. Authors have full consent from their employers and funding bodies to submit this manuscript.

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Comments

Chronic Subdural Hematomas (CSDH) are typically diagnosed by a computed tomography (CT) scan after head injury. Nevertheless, the appearance at time of diagnosis is not uniform, and while little is known about the time correlation between the radiological appearance and the head injury, it is an issue often debated in i.e. legal matters. In this study, the authors performed a large nation-wide study aimed at correlating radiological phenotype of CSDH to the time of head injury, while strengthening their analysis with a regression model.

The authors identify membranous CSDH as having longer time from head injury to diagnosis than homogenous, separated and mixed CSDH. As such, the study provides simple but clinically relevant and novel insights in the field of CSDH.

Jiri Bartek

Stockholm, Sweden

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Jensen, T.S.R., Andersen-Ranberg, N., Poulsen, F.R. et al. The Danish Chronic Subdural Hematoma Study—comparison of hematoma age to the radiological appearance at time of diagnosis. Acta Neurochir 162, 2007–2013 (2020). https://doi.org/10.1007/s00701-020-04472-w

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  • DOI: https://doi.org/10.1007/s00701-020-04472-w

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