Risk Factors of Chronic Subdural Hematoma Recurrence: A Systematic Review
Bibliographic record
Abstract
Background: Although various factors have been proposed in connection with the recurrence of chronic subdural hematoma (cSDH), the results obtained in previous studies have not been consistent. This study was conducted to describe the risk factors for cSDH recurrence, drawing upon the current literature, and to provide an integrative framework that links these factors with underlying biological mechanisms. Methods: In December 2024, a systematic literature search was performed using the Scopus, Web of Science, PubMed, and Embase electronic databases. The retrieved records were screened against eligibility criteria and selected in 2 stages. The Newcastle-Ottawa Scale (NOS) was utilized for bias assessment, and the PRISMA (Preferred Reporting Items for Systematic Reviews) checklist was employed to assess the methodological rigor and reliability of the selected studies and their findings. Results: After applying the inclusion and exclusion criteria, 61 studies were retained for the systematic review. The principal risk factors associated with the recurrence of cSDH were elucidated and correlated with underlying pathophysiological processes. Lower Glasgow Coma Scale (GCS) scores and elevated postoperative neutrophil counts indicate increased inflammation. The use of antiplatelet and anticoagulant agents reflects coagulation dysfunction, which raises the risk of rebleeding. Additional factors such as male sex, older age, larger hematoma size, and shorter drainage duration relate to anatomical and clinical vulnerability. Radiological signs, such as high hematoma density and midline shift, support the role of structural brain changes. Comorbidities, including diabetes and hypertension, exacerbate vascular fragility, increasing recurrence risk. Early detection, effective postoperative drainage, and higher serum HDL levels contribute to a reduced risk of recurrence. Conclusion: cSDH recurrence results from the complex interplay of biological processes, including inflammation, coagulation dysfunction, and structural brain changes, with clinical risk factors. Recognizing and targeting these integrated pathways is crucial for improving prevention and management strategies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.028 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.008 |
| Bibliometrics | 0.012 | 0.012 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".