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Factors influencing wait-and-watch management in mild primary chronic subdural hematoma: a retrospective case–control study

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Abstract

Purpose

To identify prognostic factors in patients with primary chronic subdural hematoma (CSDH) undergoing wait-and-watch management.

Methods

A case–control study was conducted in a single center from February 2019 to November 2021 to identify independent influencing factors of wait-and-watch management in mild CSDH patients using wait-and-watch as monotherapy. A total of 39 patients who responded to wait-and-watch management (cases) and 24 nonresponders (controls) matched for age, sex, height, weight, MGS-GCS (Markwalder grading scale and Glasgow Coma Scale), and bilateral hematoma were included. Demographics, blood cell counts, serum biochemical levels, imaging data, and relevant clinical features at baseline were collected.

Results

Univariate analysis revealed significant differences between cases and controls in hematoma volume, ability to urinate, maximal thickness of the hematoma, and hypodensity of the hematoma. Hypodense hematoma and hematoma volume were independently associated with the outcome in multivariate analysis. Combining these independently influencing factors revealed an area under the receiver operator characteristic curve of 0.741 (95% CI 0.609–0.874, sensitivity = 0.783, specificity = 0.667).

Conclusions

The results of this study may aid in identifying patients with mild primary CSDH who could benefit from conservative management. While wait-and-watch management may be an option in some cases, clinicians need to suggest medical interventions, such as pharmacotherapy, when appropriate.

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Funding

This research was supported by the National Natural Science Foundation of China (Nos. 81671221, 81271359, and 81671380); Beijing Tianjin Hebei Basic Research Cooperation Project: Grant Number 19JCZDJC64600 (Z); the Tianjin Research Program of Application Foundation and Advanced Technology (No.19YFZCSY00650) and The Clinical Study of Tianjin Medical University (2017kylc007).

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Author notes

  1. Xinjie Zhang, Zhuang Sha and Chuang Gao These authors have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China

    Xinjie Zhang, Zhuang Sha, Chuang Gao, Jiangyuan Yuan, Jinhao Huang & Rongcai Jiang

  2. Ministry of Education, Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Tianjin, China

    Xinjie Zhang, Zhuang Sha, Chuang Gao, Jiangyuan Yuan, Jinhao Huang & Rongcai Jiang

  3. Department of Neurology, Chengde Central Hospital, Chengde, 067000, Hebei, China

    Lei He

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  1. Xinjie Zhang
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethical Committee of Tianjin Medical University General Hospital and with the 1964 Helsinki Declaration and its later amendments or ROC, receiver operating characteristic. comparable ethical standards. For this type of retrospective study, formal consent is not required.

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Zhang, X., Sha, Z., Gao, C. et al. Factors influencing wait-and-watch management in mild primary chronic subdural hematoma: a retrospective case–control study. Acta Neurol Belg 123, 2277–2286 (2023). https://doi.org/10.1007/s13760-023-02293-z

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