A prospective study of chronic subdural haematomas in elderly patients

Objective: to study clinical features and prognosis of older people with chronic subdural haematoma who present to an elderly medicine department rather than a neurosurgical unit. Design: prospective descriptive study with immediate and 6-month follow-up. Subjects: patients aged 75 and over with chronic subdural haematoma presenting to an elderly medicine service, selected on the basis of age alone. Methods: information was taken from inpatient notes and computerized tomographs and, for 6-month follow-up, from outpatient clinics, inpatient notes or via the general practitioner. Results: the most common presenting features were falls and progressive neurological deficit. 42% of patients were known to be confused before their chronic subdural haematoma. Only 37% of the patients were treated by neurosurgeons. The others were managed conservatively either because they were unfit for surgery or the haematoma was small. There was only one death related to surgery but 31% of patients died within 6 months of diagnosis. Conclusion: Elderly patients in neurosurgical series are a selected subgroup of older patients with subdural haematoma.