Frequency of conservatively managed traumatic acute subdural haematoma changing into chronic subdural haematoma (original) (raw)
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One hundred and twenty-seven cases of acute subdural haematoma operated on
Acta Neurochirurgica, 1996
Traumatic acute subdural haematoma is one of the most lethal of all head injuries: the mortality rate is reported to be between 50 and 90%. We reviewed the clinical records of 1688 head injured patients admitted to the Department of Neurosurgery at C.T.O. hospital between 1982 and 1992. In 127 cases (7,5%)CTscan on admission showed acute subdural haematoma requiring surgery because the midline shift was greater than 5 ram. The overall mortality rate was 57% and 23% had functional recovery. The following variables were assessed with regard to morbidity and mortality: mechanism of injury, age, neurological presentation, time delay from injury to intervention, CTscan finding on admission. GCS and CTscan findings were found to be the most important prognostic variable. Timing of operative intervention for clot removal with regard to outcome was not statistically significant. But no conclusions regarding the importance of early haematoma evacuation can be drawn from such an oversimplifying statement, because it does not take into account factors like rapidity of haematoma development and related brain decompensation as well as additional direct brain lesions. The results of this study suggest that the extent of primary brain injury underlying the subdural haematoma is the most important factor affecting outcome.
Traumatic subdural haematoma: integrating case-based clinical judgement with guidelines
BMJ Case Reports
Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity with a significant loss of functional capacity and a huge socioeconomic burden. Road traffic accidents are the most common (60%) cause followed by falls and violence in India and worldwide. This case discusses the story of a 23-year-old man with severe TBI–subdural haematoma, who presented in a comatose state. The patient was a purported candidate for emergency decompressive surgery as per Brain Trauma Foundation (BTF) guidelines but was managed conservatively. This case questions the plausibility of the BTF guidelines for severe TBI, particularly in rural hospitals in India and how such cases are often managed with clinical judgement based on the review of literature. The patient recovered well with a perfect 8/8 on Glasgow Outcome Scale Extended Score.
Acute Subdural Hematomas; management, complications and outcome -a tertiary center experience AUTHOR
Background: acute subdural hematoma is the most common traumatic intracranial hematoma which carries highest mortality. It's a type of hemorrhage that occurs beneath the dura and is usually associated with other brain injuries. These a number of variables include like age, mechanism of injury, neurological condition on admission, postoperative intracranial pressure (ICP), and time of injury to surgical evacuation contribute to mortality and morbidity in acute SDH. In the present study the management, complications and outcome of acute SDH will be studied. Methods: The study was prospective in nature conducted on all patients of acute subdural hematoma admitted in the Department of neurosurgery, Sher-I-Kashmir Institute of Medical Sciences (SKIMS) Srinagar for a period of two years between June 2015-August 2017. 150 patients diagnosed with acute subdural hematoma were recruited into the study. Results: In this study acute subdural hematoma was most common in the age group of 21-30 year which was 22% followed by age group of 31-40 years which was about 21.3% with male predominance in all age groups. Most common mode of head injury was road traffic accidents which was found in 67 patients (44.7%) followed by fall from height which was found in 59 patients (39.3%). Most common symptom in acute SDH was Loss of consciousness in 50(33.3 %) patients followed by Vomiting in 43 (28.66%). Glasgow coma scale (GCS) <8 at presentation was found in 73(48.66%) patients followed by GCS of 9-12 in 39(26%) patients. Unilateral dilated pupil which was found in majority of patients. Most patients had thicker SDH>10 mm (50.66%) with significant midline shift and associated contusion (35.33%). Most common location of acute subdural hematoma was in fronto-temporo-parietal region which was found in 44.7% of patients followed by temporal region which was found in 30.7% of patients. Only a minority of patients (20%) were managed conservatively. Most common postoperative complication during hospital stay in our study was chest infection in 30% of patients followed by sepsis in 19.33% of patients. With age there is increase in mortality. Mortality is highest in age group of 60-65 which is 86.20% and lowest in 1-20 age group which is 26.08%. Mortality of Acute subdural hematoma with associated SAH is 55.55% followed by patients associated with Contusion which is 49.05%. Mortality of Acute subdural hematoma with associated SAH is 55.55% followed by patients associated with Contusion which is 49.05%. Mortality rate increased with delay in surgery with delay of >12 hours the mortality is 58.82%. Most of the patients presented with GCS< 8 at the time of presentation to hospital and had a mortality of 78.08%, which indicates very bad prognosis. Conclusion: Traumatic acute SDH is a fatal condition despite all developments in neurosurgical interventions. GCS score, hematoma size, midline shift and associated brain injury are important parameters influencing mortality and morbidity. Early intubation, hyperventilation, prevention and treatment of shock, and surgical decompression and management of increased intracranial pressure are basic requisites for meaningful recovery in patients with severe head injury and acute subdural hematoma.
Prognosis of isolated acute post-traumatic subdural haematoma
Journal of neurosurgical sciences, 2007
Acute subdural haematoma (ASDH) is seldom an isolated lesion and it is difficult to understand the mechanisms which determine the poor prognosis associated to this occurrence. Aim of this study was estimating the outcome of patients with ASDH without any companion lesions by analysing the haematoma volume, its thickness and midline shift. Twenty-eight severely head injured patients (Glasgow Coma Scale, GCS =/<8) with isolated unilateral ASDH admitted in intensive care unit (ICU) were retrospectively studied. The haematoma thickness, the midline shift, the ASDH volume were obtained from the first emergency computerized tomography (CT) scan and analysed by a computer assisted programme (Osiris). Patients' outcome was scored according to the Glasgow Outcome Scale (GOS) 6 months after the event. According to their GOS the patients were further divided in 2 groups (favourable outcome: GOS 4-5, poor outcome: GOS 1-2-3). Midline shift ranged from 0 to 19.2 mm; we found a larger midl...
BMJ Open
IntroductionControversy exists about the optimal treatment for patients with a traumatic acute subdural haematoma (ASDH) and an intracerebral haematoma/contusion (t-ICH). Treatment varies largely between different regions. The effect of this practice variation on patient outcome is unknown. Here, we present the protocol for a prospective multicentre observational study aimed at comparing the effectiveness of different treatment strategies in patients with ASDH and/or t-ICH. Specifically, the aims are to compare (1) an acute surgical approach to an expectant approach and (2) craniotomy to decompressive craniectomy when evacuating the haematoma.Methods and analysisPatients presenting to the emergency room with an ASDH and/or an t-ICH are eligible for inclusion. Standardised prospective data on patient and injury characteristics, treatment and outcome will be collected on 1000 ASDH and 750 t-ICH patients in 60–70 centres within two multicentre prospective observational cohort studies: ...
The Lancet Neurology
Background Despite being well established, acute surgery in traumatic acute subdural haematoma is based on low-grade evidence. We aimed to compare the effectiveness of a strategy preferring acute surgical evacuation with one preferring initial conservative treatment in acute subdural haematoma. Methods We did a prospective, observational, comparative effectiveness study using data from participants enrolled in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) cohort. We included patients with no pre-existing severe neurological disorders who presented with acute subdural haematoma within 24 h of traumatic brain injury. Using an instrumental variable analysis, we compared outcomes between centres according to treatment preference for acute subdural haematoma (acute surgical evacuation or initial conservative treatment), measured by the case-mix-adjusted percentage of acute surgery per centre. The primary endpoint was functional outcome at 6 months as rated with the Glasgow Outcome Scale Extended, which was estimated with ordinal regression as a common odds ratio (OR) and adjusted for prespecified confounders. Variation in centre preference was quantified with the median OR (MOR). CENTER-TBI is registered with ClinicalTrials.gov, number NCT02210221, and the Resource Identification Portal (Research Resource Identifier SCR_015582).
Bang. J Neurosurgery, 2017
Background: Acute subdural haematoma is haematoma within the dura & arachnoid mater presenting within 72 hours of injury. It is caused by high speed impact that accelerates the brain relative to the fixed dural structure tearing the bridging veins that traverse between the cortical surface & venous sinuses. Small Acute Subdural haematoma less than 5 mm thick on axial CT images, without sufficient mass effect to cause shifting of midline less than 5 mm can be managed conservatively. Objective: The objective of this study is to asses the morbidity & mortality following conservative management of traumatic acute subdural haematoma.
2019
Introduction: Traumatic Brain Injury (TBI) is a common cause of morbidity and mortality worldwide. Post traumatic acute subdural hematoma, one of the most difficult tasks faced by neurosurgeons. Reliable prognostic factors for acute subdural hematoma to improve the surgical results in these patients are important. The magnitude of this study outcome of early intervention for removal of acute sub dural hematoma, may decrease the morbidity and mortality. Objective: Functional outcome of the patients with acute subdural hematoma treated surgically within 4 hrs. of injury. Setting: The study was conducted in Department of Neurosurgery, Liaquat National Hospital Karachi. Study design: Case series. Subject and Methods: A total of 100 patients having acute subdural hematoma diagnosed on CT scan brain who underwent surgical intervention were included in this study. Detailed history, clinical examination and GCS assessment were performed. Surgery was performed by consultant neurosurgeon. Pat...
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 2021
Background Traumatic acute subdural haematoma occurs in about 10–20% of patients with severe head injuries. This study aims to investigate the relation between outcome and the age, Glasgow Coma Scale on admission as well as haematoma thickness upon admission CAT scan. This is a prospective observational clinical trial study of 39 patients with isolated traumatic acute subdural haematomas treated with conservative or surgical procedures during a one-year study period. Results There was a statistically significant relation between Glasgow Outcome Score and both age of the patients and Glasgow Coma Scale upon admission. However, there was a non-statistically significant relationship between Glasgow Outcome Score and haematoma thickness upon admission CAT scan. Conclusions Age of the patients with traumatic acute subdural haematoma as well as Glasgow Coma Scale upon admission are essential predictors of the outcome. Clinical trial registration details: Name of the registry: Traumatic Ac...
2021
In the present study, we aimed to assess and analyze the predictive factors of 30‐day mortality in patients with acute subdural hematoma (ASDH) who underwent surgical intervention after traumatic brain injury (TBI). We conducted a retrospective study, which included a cohort of 135 consecutive patients diagnosed with ASDH who required surgical evacuation. We assessed the demographic and clinical data, the imaging data of the hematoma described by preoperative computed tomography (CT) and the type of neurosurgical intervention for hematoma evacuation via either craniectomy or craniotomy. The patients were followed up for 30 days after head trauma and the occurrence of death was noted. Death was recorded in 63 (46.6%) patients at 30 days after TBI. There was a significant number of deceased patients who underwent craniectomy (71.4%). The Glasgow Coma Scale (GCS) was statistically significantly lower in patients who died (P<0.001), with a cut‐off value of ≤12, under which the probab...