Imaging-based prediction of chronic subdural hematoma recurrence: a simplified computed tomography–derived model: a retrospective study of South Korea

Objective: Chronic subdural hematoma (CSDH) is becoming increasingly prevalent, and recurrence after burr-hole drainage remains a major challenge in neurosurgical care. This study aimed to develop a simplified model for predicting CSDH recurrence from structural features derived from perioperative computed tomography (CT).Methods: This retrospective observational study included 330 patients who underwent burr-hole drainage for CSDH. Recurrence was defined as subdural hematoma reaccumulation on follow-up CT accompanied by neurological deterioration requiring reoperation. Univariate and multivariable logistic regression analyses were performed to identify independent imaging predictors of recurrence. The multivariable model was fitted to complete-case data from 156 patients, including 13 with recurrence. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC).Results: Recurrence occurred in 29 of the 330 patients (8.8%). Univariate analysis showed significant or near-significant associations of recurrence with asymptomatic contralateral hematoma (odds ratio [OR], 2.867; 95% confidence interval [CI], 1.221–6.539; P=0.01), septation (OR, 0.195; 95% CI, 0.030–0.744; P=0.04), and midline shift. Multivariable analysis identified asymptomatic contralateral hematoma as the strongest independent predictor of recurrence (OR, 6.469; 95% CI, 1.935–23.677; P=0.003), whereas septation was independently associated with lower recurrence risk (OR, 0.211; P=0.03). The model showed acceptable discrimination for recurrence (AUC, 0.772; 95% CI, 0.627–0.916), although internal validation indicated mild overfitting (optimism-corrected AUC, 0.738; calibration slope, 0.819).Conclusion: A small set of structural features derived from perioperative CT, particularly the presence of an asymptomatic contralateral hematoma, may help identify patients at higher risk of CSDH recurrence after burr-hole drainage.