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

Acta Neurochir (Wien). 2023 Jan;165(1):49-59. doi: 10.1007/s00701-022-05435-z. Epub 2022 Dec 10.


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.

Keywords: Chronic subdural hematoma; Epidemiology; Low- and middle-income countries; Neurotrauma; Traumatic brain injury.

MeSH terms

  • Aged
  • Drainage
  • Ethiopia / epidemiology
  • Hematoma, Subdural, Chronic* / diagnostic imaging
  • Hematoma, Subdural, Chronic* / surgery
  • Humans
  • Middle Aged
  • Recurrence
  • Retrospective Studies
  • Treatment Outcome