Letter to Editor Regarding:Nomogram-Based Prediction of Chronic Subdural Hematoma Recurrence: Considerations for Clinical Application

This letter comments on the nomogram developed by Zeng et al. for predicting chronic subdural hematoma (CSDH) recurrence after single burr-hole drainage, which achieved 70.5% sensitivity but only 45.9% specificity. We highlight that this modest specificity carries a meaningful risk of misclassifying low-risk patients as high-risk, potentially prompting unnecessary imaging or intensified follow-up. We further note that the retrospective, single-center design and small number of recurrence events (32 of 279 patients) limit the model's robustness, and that clinically relevant variables such as age, sex, alcohol use, and anticoagulant therapy were not included. We also raise a methodological point regarding the inclusion of postoperative predictors, such as brain re-expansion and Glasgow Outcome Scale, in a model intended to guide postoperative management, and suggest that the intended prediction time point should be explicitly defined. We conclude that external validation in larger, multicenter cohorts is needed before this nomogram can be adopted for routine clinical decision-making.

Chronic subdural hematoma Burr-hole drainage Nomogram