The outcome from acute subdural and epidural intracranial haematomas in very elderly patients

Br J Neurosurg. 1992;6(3):227-31. doi: 10.3109/02688699209002930.


Out of a consecutive series of 1082 operations performed on head-injured patients over a 9-year period, 28 cases of acute subdural haematomas (SDHs) or epidural haematomas (EDHs) occurring in patients aged between 80 and 100 years were selected. Mortality rates in these patients (100% in 2 EDHs, 88% in 26 SDHs) were significantly higher (p less than 0.01) compared with patients under 80 years (12% in 308 EDHs, 57% in 215 SDHs). Pre-existing diseases, primary events precipitating falls, and multiple system failure complicating the postoperative course accounted for most of the deaths. None of the patients operated upon with a Glasgow Coma Scale score of 11 or less survived. A typical 'talk and die' course occurred in two cases. Three patients, all operated on for SDH, survived and returned to their pre-injury conditions. It was concluded that, whilst the question as to whether to submit very old comatose patients to life-prolonging measures remains unsettled, there is a case for the prompt evacuation of extra-axial clots in patients with minimal impairment of consciousness.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Frail Elderly / statistics & numerical data*
  • Hematoma, Epidural, Cranial / mortality
  • Hematoma, Epidural, Cranial / surgery*
  • Hematoma, Subdural / mortality
  • Hematoma, Subdural / surgery*
  • Humans
  • Male
  • Postoperative Complications / mortality*
  • Retrospective Studies
  • Survival Rate