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Surgical treatment and outcome of chronic subdural hematoma: a comparative study between Ethiopia and Norway

  • Original Article - Brain trauma
  • Published:
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Abstract

Background

Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. Here, we studied differences in demographics, treatment, and outcome for CSDH patients in low-income (Ethiopia) and high-income (Norway) countries and assessed potential outcome determinants.

Methods

We included patients from Addis Ababa University Hospitals (AAUH) and Haukeland University Hospital (HUH) who had surgery for CSDH (2013–2017). Patients were included prospectively in Ethiopia and retrospectively in Norway.

Results

We enrolled 314 patients from AAUH and 284 patients from HUH, with a median age of 60 and 75 years, respectively. Trauma history was more common in AAUH (72%) than in HUH patients (64.1%). More patients at HUH (45.1%) used anticoagulants/antiplatelets than at AAUH (3.2%). Comorbidities were more frequent in HUH (77.5%) than in AAUH patients (30.3%). Burr hole craniostomy under local anesthesia and postoperative drainage was the standard treatment in both countries. Postoperative CT scanning was more common at HUH (99.3%) than at AAUH (5.2%). Reoperations were more frequent at HUH (10.9%) than at AAUH (6.1%), and in both countries, mostly due to hematoma recurrence. Medical complications were more common at HUH (6.7%) than at AAUH (1.3%). The 1-year mortality rate at HUH was 7% and at AAUH 3.5%. At the end of follow-up (> 3 years), the Glasgow Outcome Scale Extended (GOSE) score was 8 in 82.9% of AAUH and 46.8% of HUH patients.

Conclusion

The surgical treatment was similar at AAUH and HUH. The poorer outcome in Norway could largely be explained by age, comorbidity, medication, and complication rates.

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Data Availability

The data that support the findings of this study are available on request from the corresponding author, Dr Tsegazeab Laeke.

Abbreviations

CSDH:

Chronic subdural hematoma

HICs:

High-income countries

LICs:

Low-income countries

HUH:

Haukeland University Hospital

AAUH:

Addis Ababa University Hospitals

EMR:

Electronic medical records

MGS:

Markwalder’s grading scale

CT:

Computed tomography

GOSE:

Glasgow outcome scale extended

BHC:

Burr hole craniostomy

GCS:

Glasgow coma scale

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Author information

Authors and Affiliations

  1. Neurosurgery Division, Surgery Department, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia

    Tsegazeab Laeke & Abenezer Tirsit

  2. Department of Clinical Medicine, University of Bergen, Bergen, Norway

    Tsegazeab Laeke, Abenezer Tirsit, Morten Lund-Johansen & Terje Sundstrøm

  3. Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway

    Line Kalleklev

  4. Center for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway

    Bente E. Moen

  5. Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway

    Morten Lund-Johansen & Terje Sundstrøm

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  1. Tsegazeab Laeke
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  2. Line Kalleklev
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Contributions

Conception and methodology design: Tsegazeab Laeke, Morten Lund-Johansen, Terje Sundstrøm, Line Kalleklev, Bente E. Moen.

Acquisition of data: Tsegazeab Laeke, Line Kalleklev, Terje Sundstrøm, Abenezer Tirsit.

Drafting the article: Tsegazeab Laeke, Morten Lund-Johansen, Terje Sundstrøm, Line Kalleklev, Abenezer Tirsit.

Manuscript reviewing and editing: Tsegazeab Laeke, Terje Sundstrøm, Morten Lund-Johansen, Bente E. Moen.

Supervision: Terje Sundstrøm, Morten Lund-Johansen, Bente E. Moen.

All authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Tsegazeab Laeke.

Ethics declarations

The authors declare no competing interests. Informed consent was obtained from all individual participants included in the study.

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Comments

This is a comparison between two populations from Ethiopia and Norway with chronic subdural hematoma. This study reveals differences regarding the outcome due to lack of early diagnosis in a Low Income Country and the presence of comorbidities in ageing population in High Income Countries. This paper will help to predict possible complications in affluent Africans who are ageing and presenting also in hospitals with comorbidities. I congratulate the authors for drawing our attention to a common pathology in both countries and how they are being managed.

Kazadi Kalangu

Harare, Zimbabwe

This article is part of the Topical Collection on Brain trauma.

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Laeke, T., Kalleklev, L., Tirsit, A. et al. Surgical treatment and outcome of chronic subdural hematoma: a comparative study between Ethiopia and Norway. Acta Neurochir 165, 49–59 (2023). https://doi.org/10.1007/s00701-022-05435-z

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