Introduction The pathophysiology of chronic subdural hematomas has remained relatively elusive with recent studies focusing in on the role of inflammation in promoting the formation and maintenance of these fluid collections. Additionally, there are not well-known predictors of radiographic outcomes in conservatively managed chronic subdural hematomas. With this study, we investigated the relationship between markers of systemic inflammation on admission with radiographic outcomes, readmission rates, and neurologic status on admission.

Materials and Methods This is a retrospective chart review of 41 patients who presented with chronic subdural hematoma between 2018–2023 and were managed conservatively without surgical or endovascular interventions. Systemic inflammation on admission, represented as the neutrophil-lymphocyte ratio (NLR) and the systemic immune-inflammation index (SII), was analyzed and compared with admission GCS, radiographic outcomes at 30-day follow-up, and readmission rates within 30 days.

Results Systemic inflammation on admission was negatively correlated with admission GCS. Patients with an increased neutrophil-lymphocyte ratio and systemic immune-inflammation index had decreased GCS on admission (NLR: Pearson r = -0.6133, P < 0.0001; SII: Pearson r = -0.5677, P = 0.0008). Additionally, patients with enlargement of their subdural on 30-day follow-up imaging had significantly higher admission NLR (P = 0.035) and SII (P = 0.032) compared to patients with resolution of their subdural and higher, though insignificantly, NLR and SII compared to patients with stable follow-up imaging. Lastly, while not statistically significant, patients readmitted within 30 days of discharge had higher NLR and SII on admission.

Conclusions These data suggest that for chronic subdural hematoma, increased systemic inflammation on admission is correlated with worsened radiographic outcomes at follow-up and worse GCS on admission. In addition, it suggests that higher systemic inflammation on admission may predict readmission after initial discharge. The results of this study imply that indices of systemic inflammation on admission for chronic subdural hematoma could be used to guide decision making about need for intervention in these patients and imply that patients with higher systemic inflammation may warrant more aggressive initial management.

Disclosures M. Tobin: None. B. Obeng-Gyasi: None. A. Colter: None. L. Ramirez: None. A. Christodoulides: None. B. Bohnstedt: 2; C; Styrker Neurovascular.