The Risk Factors Of Chronic Subdural Hematoma After Mild Traumatic Brain Injury In The Young And Middle-aged Patients

Objective: To investigate the risk factors of chronic subdural hematoma(CSDH)after mild traumatic brain injury(TBI)in the Young and Middle-aged Patients in order to take measure early to reduce the incidence of chronic subdural hematoma.Methods: We retrospectively reviewed the young and middle-aged patients admitted to our hospital with mild TBI with positive CT finding from January 2018 through Mary 2019.A total of 236 patients were divided into the young group(18~44 years old)and the middle-aged group(45~60 years old).Gender,age,the cause of injury,damage mechanism,maximal width of subdural space,CT findings,arachnoid cyst,anticoagulant/antiplatelet agent therapy,coagulation status such as APTT ? PT at admission,drinking/smoking,and underlying diseases including hypertension,diabetes mellitus,cerebral infarction,brain surgery,disorder of blood coagulation were counted.Patients were followed up,and based on formation of CSDH,they were divided again into CSDH groups and no CSDH groups.Then univariate and multivariate stepwise logistic analysis were performed to assess the risk factors related to CSDH after mild TBI in the two age groups.Results: According to the result of univariate analysis,in the young patients,differences between CSDH group and no CSDH group in the maximal width of subdural space,arachnoid cyst,acute epidural hematoma and skull fracture were statistically significant(p<0.05).In the middle-aged patients,besides the above four factors,hypertension,diabetes mellitus,anticoagulant/antiplatelet agent therapy,drinking,smoking,APTT and PT were statistically different between the experimental group and the control group(P<0.05).Logistic regression analysis showed that maximal width of subdural space,skull fracture and arachnoid cyst are independently related to CSDH in the young patients;and in the middle-aged patients,maximal width of subdural space,skull fracture,anticoagulant/antiplatelet agent therapy and hypertension were independently related to CSDH.Then the ROC curves of maximal width of subdural space was drew.ACU of the curves were 0.780 and 0.855,and the best cut off value were 3.5mm and 2.6mm.Conclusion:(1)The independent risk factors of CSDH after m TBI in the young patients were maximal width of subdural space,skull fracture and arachnoid cyst;and in the middle-aged patients,the independent risk factors were maximal width of subdural space,skull fracture,anticoagulant/antiplatelet agent therapy and hypertension.(2)There were other factors related to the formation of CSDH,including acute epidural hematoma in the young patients,acute epidural hematoma,arachnoid cyst,diabetes mellitus,drinking,smoking,APTT and PT in the middle-aged patients.(3)3.5mm of the maximal width of subdural space was a predictor of CSDH in the young patients.Like it,2.6mm might be used to a predictor in the middle-aged patients.(4)Patients with the above clinical characteristics should be paid more attention to in order to early find of CSDH.