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Peer-reviewedCC BY 4.0Irish Journal of Medical Science

Decision making in chronic subdural haematoma patient referrals in an octogenarian and nonagenarian population – a multi-centre perspective

  • Joshua MacArthur1
  • Sayan Biswas2
  • Lareyna McMenemy1
  • Keneth Kodituwakku1
  • Gokul Raj Krishna3
  • Saskia Swannack4
  • Samuel Wiltshire4
  • Mohammad Saleemi5
  • Helena Thompson2
  • Anand Pandit6,7
  • Ved Sarkar8
  • Ahmed Toma7
2 more authors
  • Emily Feilding9
  • K. Joshi George5
9 affiliations
  1. 1Faculty of Biology, Medicine and Health, University of Manchester, Manchester, Greater Manchester UK
  2. 2Specialized Foundation Doctor Training Programme, Edge Hill University, Omskirk, England L39 4QP UK
  3. 3Department of Surgery, Manchester University NHS Foundation Trust, Manchester, Greater Manchester UK
  4. 4Department of Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, England, UK
  5. 5Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Manchester, UK
  6. 6High-Dimensional Neurology, Institute of Neurology, University College London, London, UK
  7. 7Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Victor Horsley, Queen Square, London, UK
  8. 8College of Letters and Sciences, University of California, Berkeley, CA 94720 USA
  9. 9Department of Geriatric Medicine, Salford Royal Hospital, Manchester, UK
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Abstract

Background: The incidence of chronic subdural haematoma (CSDH) is rising in the elderly, yet there is limited research focusing on patients aged > 80. In the United Kingdom, the decision to transfer for neurosurgical intervention is dependent upon the acceptance of a CSDH management referral by a tertiary centre.

Aims: This study thus aims to identify key predictors of referral acceptance in octogenarian and nonagenarian age groups, in comparison to the adult population.

Methods: A multi-centre retrospective case series analysis from January 2015 to May 2020 was conducted. Patients were grouped as < 80 (‘adult’) or > 80 (‘ultra-geriatric’), with the latter further subgrouped into 80–89 (‘octogenarian’), and ≥ 90 (‘nonagenarian’). Multivariable logistic regression assessed age, headache, dementia, motor weakness, midline shift, CSDH size, and premorbid quality of life (QoL) to determine predictors of referral acceptance.

Results: With a total of 3002 patient referrals, referral acceptance was significantly higher in adults compared to the ultra-geriatric group (38.1%vs22.4%, p < 0.001) and in octogenarians versus nonagenarians (27.7%vs10.5%, p = 0.036). CSDH size and premorbid QoL were consistent independent predictors across all age groups. In adults, all seven variables were significant predictors. For the ultra-geriatric group, all but headache and dementia were significant. Among octogenarians, motor weakness, midline shift, CSDH size, and premorbid QoL predicted acceptance, while in nonagenarians, only age, CSDH size, and QoL were significant.

Conclusions: We demonstrate the importance of CSDH size and premorbid QoL as independent predictor variables for neurosurgical referral acceptance in all analysed age groups, particularly in the octogenarian and nonagenarian patient population, whilst other variables had variable significance depending upon age group.

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Cite

BibTeXRIS
BibTeX
@article{macarthur2026decision,
  title = {{Decision making in chronic subdural haematoma patient referrals in an octogenarian and nonagenarian population – a multi-centre perspective}},
  author = {Joshua MacArthur and Sayan Biswas and Lareyna McMenemy and Keneth Kodituwakku and Gokul Raj Krishna and Saskia Swannack and Samuel Wiltshire and Mohammad Saleemi and Helena Thompson and Anand Pandit and Ved Sarkar and Ahmed Toma and Emily Feilding and K. Joshi George},
  journal = {Irish Journal of Medical Science},
  year = {2026},
  month = may,
  doi = {10.1007/s11845-026-04330-1},
  url = {https://doi.org/10.1007/s11845-026-04330-1},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Decision making in chronic subdural haematoma patient referrals in an octogenarian and nonagenarian population – a multi-centre perspective
AU  - Joshua MacArthur
AU  - Sayan Biswas
AU  - Lareyna McMenemy
AU  - Keneth Kodituwakku
AU  - Gokul Raj Krishna
AU  - Saskia Swannack
AU  - Samuel Wiltshire
AU  - Mohammad Saleemi
AU  - Helena Thompson
AU  - Anand Pandit
AU  - Ved Sarkar
AU  - Ahmed Toma
AU  - Emily Feilding
AU  - K. Joshi George
PY  - 2026
DA  - 2026/05/14
JO  - Irish Journal of Medical Science
DO  - 10.1007/s11845-026-04330-1
UR  - https://doi.org/10.1007/s11845-026-04330-1
AB  - Background: The incidence of chronic subdural haematoma (CSDH) is rising in the elderly, yet there is limited research focusing on patients aged > 80. In the United Kingdom, the decision to transfer for neurosurgical intervention is dependent upon the acceptance of a CSDH management referral by a tertiary centre.  Aims: This study thus aims to identify key predictors of referral acceptance in octogenarian and nonagenarian age groups, in comparison to the adult population.  Methods: A multi-centre retrospective case series analysis from January 2015 to May 2020 was conducted. Patients were grouped as < 80 (‘adult’) or > 80 (‘ultra-geriatric’), with the latter further subgrouped into 80–89 (‘octogenarian’), and ≥ 90 (‘nonagenarian’). Multivariable logistic regression assessed age, headache, dementia, motor weakness, midline shift, CSDH size, and premorbid quality of life (QoL) to determine predictors of referral acceptance.  Results: With a total of 3002 patient referrals, referral acceptance was significantly higher in adults compared to the ultra-geriatric group (38.1%vs22.4%, p < 0.001) and in octogenarians versus nonagenarians (27.7%vs10.5%, p = 0.036). CSDH size and premorbid QoL were consistent independent predictors across all age groups. In adults, all seven variables were significant predictors. For the ultra-geriatric group, all but headache and dementia were significant. Among octogenarians, motor weakness, midline shift, CSDH size, and premorbid QoL predicted acceptance, while in nonagenarians, only age, CSDH size, and QoL were significant.  Conclusions: We demonstrate the importance of CSDH size and premorbid QoL as independent predictor variables for neurosurgical referral acceptance in all analysed age groups, particularly in the octogenarian and nonagenarian patient population, whilst other variables had variable significance depending upon age group.
SN  - 0021-1265
SN  - 1863-4362
ER  -