Tag: Prediction model

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Predicting chronic subdural hematoma risk in elderly patients with mild traumatic brain injury

Acta Neurochirurgica (2026) 168:40

This study develops and validates a concise bedside risk score to predict chronic subdural hematoma (CSDH) within 2–12 weeks after mild traumatic brain injury in patients aged 65+. Using a large retrospective cohort (7,246 events) and multivariable modeling, pathological CT at presentation, male sex, older age, and renal failure emerged as key predictors.

The score-based model (including anticoagulant use by expert choice) achieved AUROC 0.76 and 86% sensitivity at the chosen threshold, classifying ~61% as high-risk. Authors propose this tool to guide targeted surveillance and earlier intervention, while noting limitations from retrospective data and need for external validation.

Pathological CT Findings: Pathological findings on initial head CT after mild traumatic brain injury (TBI) are the strongest predictor for developing chronic subdural hematoma (CSDH) within 2–12 weeks in elderly patients.

Key Risk Factors: Older age, male sex, and renal failure are also significant independent predictors for CSDH following mild TBI.

Anticoagulant Use: Chronic use of anticoagulant medications showed a trend toward increased risk but was not statistically significant in this cohort; antiplatelet use was not associated with increased risk.

Prediction Model: A simple score-based risk model was developed, incorporating pathological CT (14 points), male sex (4), renal failure (4), anticoagulant use (4), and age (1 point per 5 years over 65), with a threshold of 5 points or higher identifying high-risk patients.

Model Performance: The risk model achieved an area under the ROC curve (AUROC) of 0.76 and a sensitivity of 86% for detecting CSDH, but the positive predictive value was low (1.6%) due to the rare occurrence of the outcome.

Clinical Implications: Early identification of high-risk patients may enable targeted surveillance, timely CT scanning, and consideration of non-surgical management options such as corticosteroids or middle meningeal artery embolization.

Population Impact: The incidence of CSDH is rising globally due to population aging and increased use of antithrombotic agents, with elderly adults being particularly at risk.

Study Scope: The findings support the use of bedside risk stratification in the emergency department for elderly patients with mild TBI, but further research is needed before widespread clinical implementation.

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Development and internal validation of a risk score for subsidence of expandable spacers in transforaminal lumbar interbody fusion (TLIF) surgery

Brain and Spine 5 (2025) 104322

This study developed and internally validated the Expandable TLIF Subsidence Index (ETSI) to predict risk of cage subsidence after TLIF surgery with expandable spacers. Key risk factors include high ASA score, non-degenerative indication, lower lumbar levels, small cage size, and posterior cage position.

• A risk score (Expandable TLIF Subsidence Index, ETSI) was developed to predict cage subsidence (CS) after transforaminal lumbar interbody fusion (TLIF) using expandable spacers.

• The study analyzed 388 patients (482 levels), finding a 31.7% CS rate at 3 months.

• Independent risk factors for CS included high ASA score, non-degenerative surgical indication, lower lumbar level, small cage size, and posterior cage position.

• The ETSI score ranges from -2 to 6; higher scores indicate higher CS risk (each point increases CS odds by about 2x).

• Modifiable risk factors (cage size and position) can reduce CS risk if addressed during surgery.

• Higher ETSI scores are also associated with increased risk of non-union/pseudarthrosis.

• The ETSI demonstrated moderate predictive performance (AUROC ≈ 0.68).

• The score may aid surgical planning and should be externally validated in future studies.

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Development and internal validation of a risk score for subsidence of expandable spacers in transforaminal lumbar interbody fusion (TLIF) surgery

Brain and Spine 5 (2025) 104322

This study developed and validated the Expandable TLIF Subsidence Index (ETSI) to predict risk of cage subsidence after TLIF surgery with expandable spacers. Key risk factors include high ASA score, non-degenerative indications, lower lumbar level, small cage size, and posterior cage position. Some risk factors are modifiable.

• A risk score (ETSI) was developed to predict cage subsidence (CS) after TLIF surgery using expandable spacers.

• Independent risk factors for CS include high ASA score, non-degenerative surgical indication, lower lumbar level, small cage size, and posterior cage position.

• ETSI ranges from -2 to 6 points and shows a moderate ability to classify CS risk (AUROC ≈ 0.68).

• Modifiable risk factors (cage size and position) can reduce CS risk if optimized by the surgeon.

• Higher ETSI scores are associated with increased risk of non-union/pseudarthrosis at 3 and 12 months.

• Anterior placement of the cage lowers subsidence risk, while posterior placement increases it.

• The study included 388 patients with a 3-month CS rate of 31.7%.

• The ETSI is the first comprehensive scoring system for CS risk with expandable TLIF cages.

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The Danish chronic subdural hematoma study—predicting recurrence of chronic subdural hematoma

Acta Neurochirurgica (2019) 161:885–894

An increasing incidence of chronic subdural hematoma (CSDH) and an unchanging high recurrence rate of 10–20% call for individualized treatment. The aim of this study was to establish individualized prediction models for the risk of recurrence treating death as a competing risk.

Methods A retrospective national cohort of unilateral CSDH was included for analysis. Using competing risk survival analysis, we tested whether available covariates were associated with the risk of recurrence. We further established a preand a postoperative prediction model, where predictors were chosen using a LASSO approach. The models were visualized in nomograms. Predictive performance was evaluated by c index and calibrations plots.

Results A total of 763 patients with surgically evacuated unilateral CSDH were included for analysis. The recurrence rate was 14% while 12% of patients died during follow-up (1 year). In our association model, hematoma size, drain type, drainage time, presence of complications, and Glasgow Coma Score were significantly associated to recurrence. Subdural drain was associated with a lower recurrence risk than subgaleal drain. The preoperative model included hematoma size, hematoma density, and history of hypertension. The postoperative model included further drain type, drainage time, and surgical complications.

Conclusion The nomograms allow easy assessment of the recurrence risk for the individual patient, providing a better possibility for individual adjustment of treatment and follow-up. The predictive performance indicates that significant unaccounted or unknown factors still remain. The association test found passive subdural drain superior to passive subgaleal drain in minimizing the risk of CSDH recurrence

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