{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:57:43Z","timestamp":1791593863275,"version":"4.3.4"},"reference-count":62,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,10]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Chronic subdural hematoma (cSDH) has a reported 10%\u201324% rate of recurrence after surgery, and prognostic models for recurrence have produced equivocal results. The objective of this study was to leverage a data mining algorithm, chi-square automatic interaction detection (CHAID), which can incorporate continuous, nominal, and binary data into a decision tree, to identify the most robust predictors of repeat surgery for cSDH patients.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n This was a retrospective cohort study of all patients with SDH from two level 1 trauma centers at a single institution. All patients underwent cSDH evacuation performed by 15 neurosurgeons between 2011 and 2020. The primary outcome was the rate of repeat surgery for recurrent cSDH following the initial evacuation. The authors used CHAID to identify relevant predictors of repeat surgery, including age, sex, comorbidities, postsurgical complications, platelet count prior to the first procedure, midline shift prior to the first procedure, hematoma volume, and preoperative use of anticoagulants, antiplatelets, or statins.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n Sixty (13.8%) of 435 study-eligible patients (average age 74.0 years) had a cSDH recurrence. These patients had 2.0 times greater odds of having used anticoagulants. The final CHAID model had an overall accuracy of 87.4% and an area under the curve of 0.76. According to the model, the predictor with the strongest association with cSDH recurrence was admission platelet count. Approximately 26% of patients (n = 23\/87) with an admission platelet count < 157 \u00d7 10\n 9<\/jats:sup>\n \/L had a cSDH recurrence, whereas none of the 44 patients with admission platelets > 313 \u00d7 10\n 9<\/jats:sup>\n \/L had a recurrence. Approximately 17% of patients in the 157\u2013313 \u00d7 10\n 9<\/jats:sup>\n \/L platelet group who had used preoperative statins required a second procedure, which was associated with a 2.3 times increased risk for repeat surgery compared to those who had not used statins preoperatively. Among those who had not used preoperative statins, a platelet count \u2264 179 \u00d7 10\n 9<\/jats:sup>\n \/L on admission for the first procedure was the strongest differentiator for a second surgery (n = 5\/22 [23%]), which increased the risk of recurrence by 4.5 times. Among the patients using preoperative statins, the use of anticoagulants was the strongest differentiator for requiring repeat surgery (n = 11\/33 [33%]).\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The described model identified platelet count on admission as the most important predictor of repeat cSDH surgery, followed by preoperative statin use and anticoagulant use. Critical cutoffs for platelet count were identified, which future studies should evaluate to determine if they are modifiable or reflective of underlying disease states.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2023.7.focus23240","type":"journal-article","created":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T09:26:22Z","timestamp":1696152382000},"page":"E4","source":"Crossref","is-referenced-by-count":4,"title":["Interaction of admission platelet count with current medications and the risk for chronic subdural recurrence"],"prefix":"10.3171","volume":"55","author":[{"given":"Shawn R.","family":"Eagle","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aditya M.","family":"Mittal","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan T.","family":"Kellogg","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Vargas","sequence":"additional","affiliation":[{"name":"Department of Neuroendovascular Surgery, Prisma Health-Upstate, Greenville, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enyinna","family":"Nwachuku","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hansen","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J.","family":"Buell","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David O.","family":"Okonkwo","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Pease","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Curr Geriatr Rep","first-page":"71","article-title":"Chronic subdural haematoma in the elderly: is it time for a new paradigm in management?","volume":"5","author":"Shapey J","year":"2016","unstructured":"Shapey J, Glancz LJ, Brennan PM. Chronic subdural haematoma in the elderly: is it time for a new paradigm in management? Curr Geriatr Rep. 2016;5(2):71\u201377."},{"issue":"3","key":"b2","series-title":"Geroscience","first-page":"1353","article-title":"The pathophysiology of chronic subdural hematoma revisited: emphasis on aging processes as key factor","volume":"44","author":"Weigel R","year":"2022","unstructured":"Weigel R, Schilling L, Krauss JK. The pathophysiology of chronic subdural hematoma revisited: emphasis on aging processes as key factor. Geroscience. 2022;44(3):1353\u20131371."},{"key":"b3","series-title":"United States Census Bureau","article-title":"The graying of America: more older adults than kids by 2035","author":"Vespa J","unstructured":"Vespa J. The graying of America: more older adults than kids by 2035. United States Census Bureau. Published March 13, 2018. Accessed August 4, 2023.https:\/\/www.census.gov\/library\/stories\/2018\/03\/graying-america.html"},{"key":"b4","series-title":"World Neurosurg","first-page":"277","article-title":"Thrombocytopenia and neurosurgery: a literature review","volume":"106","author":"Li D","year":"2017","unstructured":"Li D, Glor T, Jones GA. Thrombocytopenia and neurosurgery: a literature review. World Neurosurg. 2017;106:277\u2013280."},{"issue":"10","key":"b5","series-title":"Acta Neurochir (Wien)","first-page":"2719","article-title":"External validation of prognostic models predicting outcome after chronic subdural hematoma","volume":"164","author":"Holl DC","year":"2022","unstructured":"Holl DC, Mikolic A, Blaauw J, External validation of prognostic models predicting outcome after chronic subdural hematoma. Acta Neurochir (Wien). 2022;164(10):2719\u20132730."},{"key":"b6","series-title":"J Clin Neurosci","first-page":"79","article-title":"Development of a prognostic scoring system to predict risk of reoperation for contralateral hematoma growth after unilateral evacuation of bilateral chronic subdural hematoma","volume":"78","author":"Zhang JJY","year":"2020","unstructured":"Zhang JJY, Wang S, Foo ASC, Development of a prognostic scoring system to predict risk of reoperation for contralateral hematoma growth after unilateral evacuation of bilateral chronic subdural hematoma. J Clin Neurosci. 2020;78:79\u201385."},{"key":"b7","series-title":"Front Pharmacol","first-page":"845386","article-title":"Effectiveness comparisons of drug therapy on chronic subdural hematoma recurrence: a Bayesian network meta-analysis and systematic review","volume":"13","author":"Yu W","year":"2022","unstructured":"Yu W, Chen W, Jiang Y, Effectiveness comparisons of drug therapy on chronic subdural hematoma recurrence: a Bayesian network meta-analysis and systematic review. Front Pharmacol. 2022;13:845386."},{"issue":"2","key":"b8","series-title":"Neurosurg Rev","first-page":"971","article-title":"Role of the patient comorbidity in the recurrence of chronic subdural hematomas","volume":"44","author":"Martinez-Perez R","year":"2021","unstructured":"Martinez-Perez R, Tsimpas A, Rayo N, Cepeda S, Lagares A. Role of the patient comorbidity in the recurrence of chronic subdural hematomas. 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