title: Outcomes in octogenarians with subdural hematomas.
abstract: OBJECTIVE
  In the majority of literature concerning age in TBI, specifically in subdural hematomas (SDH), the mean age of patients considered elderly is 55-65. Limited data in SDH patients>75 years suggest an increased mortality rate. The impact of medical decision making on these data is not well-documented.
  
  
  METHODS
  We use the Nationwide Inpatient Sample (NIS) database to compare outcomes between SDH patients 60-79 and ≥80. As administrative databases have some shortcomings, i.e. in-hospital data only, acute and chronic SDHs listed together, we examined institutional data to evaluate the impact of these factors on medical decision making which may falsely elevate mortality rates.
  
  
  RESULTS
  In-hospital mortality was increased in NIS patients>80 treated both surgically and non-surgically (P<0.05). Our institutional data confirmed higher in-hospital mortality rates in patients>80 with SDHs as a group. However, the SDH patients>80 who underwent surgery at our institution had much lower mortality rates. We found that patients≥80 made up 87% of all patients with "surgical lesions" that were not operated on. Type of subdural, admission GCS, and baseline cognitive status appeared to have a significant impact on surgical decision making.
  
  
  CONCLUSIONS
  This study examines mortality rates in patients>80 with SDHs who are managed surgically and non-surgically using a large administrative database and institutional data. It provides preliminary insight into medical decision making which make affect mortality rates of the very elderly.
authors: Division of Neurosurgery, Albany Medical College, Albany, NY 12208, USA. jpilitsis@yahoo.com
authors: Julie
authors: J
authors: Pilitsis
authors: Britney
authors: B
authors: Atwater
authors: Daniel
authors: D
authors: Warden
authors: Gina
authors: G
authors: Deck
authors: James
authors: J
authors: Carroll
authors: Jillian
authors: J
authors: Smith
authors: Sing Chau
authors: SC
authors: Ng
authors: Jennifer
authors: J
authors: Tseng
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition / Q000502:physiology; D015331:Cohort Studies; D015897:Comorbidity; D003627:Data Interpretation, Statistical; D016208:Databases, Factual; D005260:Female; D015600:Glasgow Coma Scale; D006408:Hematoma, Subdural / Q000401:mortality / Q000628:therapy*; D020200:Hematoma, Subdural, Chronic; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009460:Neurologic Examination; D010347:Patient Care Planning; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Elderly; NIS; National database; Subdural hematoma