Rates of chronic subdural hemorrhages (SDH) – brain bleeds – are rising in the United States, and researchers conclude the condition could become the most common adult brain disorder requiring surgery by year 2030. The projection is particularly troublesome because the anticipated increase in these cases could leave hospitals undermanned, and neurosurgeons overwhelmed.
“Neurological outcomes are poor, resulting in significant disability” for up to 20 percent of patients with chronic SDH, and hospital stays for treatment of the disorder can be lengthy, said the researchers, from New York University Langone Medical Center, who were writing in the March online edition of the Journal of Neurosurgery.
“The projected increase in cases of chronic subdural hematomas is worrisome,” said Dr. Franco Campanella, neurologist in the Neurosciences Institute at Advocate Christ Medical Center in Oak Lawn, Ill., who commented on the study. “If the numbers prove accurate, treatment for this condition could become the most common neurosurgical procedure performed by 2030.”
Evidence shows that a hospital stay following treatment for chronic SDH can be significantly greater than that for surgery to remove a brain tumor. That means hospitals could be faced with growing numbers of neurosurgical inpatients as cases of chronic SDH continue to rise. SDH patients also tend to require more intensive physical therapy and rehabilitation than other cranial surgery patients, Dr. Campanella said.
Although, historically, SDH has been attributed to head trauma, cause of the disorder is oftentimes the result of conditions of aging, including degenerative brain diseases and brain atrophy, greater use of blood-thinning medications and the increased fragility of the blood vessels between the surface of the brain and its coverings. In these cases, even minor head bumps – the kind that most people cannot even remember occurred – can lead to serious bleeding complications of the brain.
The researchers evaluated more than 875,000 unique visits of patients treated at a Veterans Affairs (VA) hospital between 2000 and 2012. They identified 695 cases of newly diagnosed subdural hematomas in the VA population, with nearly 30 percent of them requiring surgical intervention, and quantified the incidence of SDH at 79.6 cases per 100,000 military veterans. More than 70 percent of SDH cases occurred in patients 65 years of age or older.
The research team also gathered information on civilian SDH-incidence rates from Finland and Japan. The data from those countries proved accurate enough to create mathematical models with which researchers could predict the occurrence of SDH between 2012 and 2040 as the general population in the United States ages.
While clinicians have known that certain populations have a greater likelihood of developing chronic SDH, precise incidence rates of the condition have not been determined until now.
Given current aging trends, the incidence of chronic SDH among veterans could jump to 121.4 cases per 100,000 by 2030 and to 17.6 cases per 100,000 persons in the general U.S. population during the same time frame, the study team indicated.
“It is imperative,” researchers wrote, “that hospitals and neurosurgeons are well equipped to treat this condition in an efficient and cost-effective manner.”