• Julie Pilitsis, Britney Atwater, Daniel Warden, Gina Deck, James Carroll, Jillian Smith, Sing Chau Ng, and Jennifer Tseng.
• Division of Neurosurgery, Albany Medical College, Albany, NY 12208, USA. jpilitsis@yahoo.com
• Clin Neurol Neurosurg. 2013 Aug 1; 115 (8): 1429-32.

ObjectiveIn 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.Patients/MethodsWe 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.ResultsIn-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.ConclusionThis 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.Copyright © 2013 Elsevier B.V. All rights reserved.

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