Nonsurgical acute traumatic subdural hematoma: what is the risk? (original) (raw)
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Analyses of clinical prognostic factors in operated traumatic acute subdural hematomas
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES
Traumatic acute subdural hematoma is the most lethal of all head injuries. In this study, 113 patients with the diagnosis of posttraumatic acute subdural hematoma, who were operated between 1998 and 2006, were reviewed retrospectively. Statistical analysis was performed to detect any effects of the variables of age, Glasgow Coma Scale (GCS) score on admission, time interval between the trauma and operation, and abnormality in the pupil reaction on the disease mortality and morbidity. Results obtained in the study are discussed and compared with the related current literature. The overall mortality in 113 patients was 56.6%. According to the results, the most important determinants of the prognosis are GCS score of the patient on admission, abnormality in pupil reaction, timing of the operation, and the patient's age.
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...
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...
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.
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).
Clinical Predictors of outcome in Isolated Traumatic Acute Subdural Hematoma
Nepal Journal of Neuroscience
Head injury is the major cause of death in young adult population worldwide with associated high morbidity. The objective of this study is to find out the outcome and factors affecting the outcome in isolated traumatic acute subdural hematoma. All patients with isolated acute subdural hematoma presenting within 24 hours of trauma and admitted over a period of 1 year were included in this study. Patient was classified according to Glasgow Coma Scale(GCS) after resuscitation in the emergency department. The outcome of the patient was recorded according to the Glasgow Outcome Scale at the time of discharge and at 3 months after the trauma in follow-up. Statistical analysis was performed to find the correlation between GCS, papillary changes and radiological finding in the form of midline shift and hematoma volume to dichotomized outcome. Out of 38 patients enrolled in the study, 33 patients had favorable outcome. Surgery was performed in 12 patients out of whom 4 patients had unfavorab...
British Journal of Neurosurgery, 2016
Background: Among traumatic brain injuries, acute subdural hematoma (aSDH) is considered one of the most devastating still retaining poor surgical outcomes in a considerable percentage of affected patients. However, according to results drawn from published samples of aSDH patients, overall mortality and functional recovery have been progressively ameliorating during the last decades. Methods: We present a retrospective analysis of 316 consecutive cases of post-traumatic aSDH operated on between 2003 and 2011 at our institution. Results: Mortality was 67% (n ¼ 212); a useful recovery was achieved in 16.4% cases (n ¼ 52). Age >65 years, a preoperative Glasgow coma scale (GCS) 8, specific pre-existing medical comorbidities (hypertension, heart diseases) were found to be strong indicators of unfavorable outcomes and death during hospitalization. Conclusion: Our results, compared with those of the inherent literature, led the authors to question both the "aggressiveness" of neurosurgical care indications in certain subpopulations of patients being known to fare worse or even die regardless of the treatment administered and the relevance of the results concerning mortality and functional recovery reported by third authors.
Turkish Neurosurgery, 2015
ASDH might be classified into traumatic or non-traumatic and acute or chronic. It usually develops as a result of rupture of the bridging veins between the dura and cerebral cortex (17). It might also be associated with rupture of dural sinuses or superior cortical arteries. Traumatic ASDH is encountered in one third of severe head traumas and the mortality rate increases up to as high as 60% (2). Traumatic ASDH is seen usually in younger individuals compared to the non-traumatic variety █ INTRODUCTION A cute subdural hematoma (ASDH) is a clinical entity with increased morbidity and mortality despite the developments in neurosurgery and urgent intervention is obviously necessary for an optimum clinical outcome (5,24). Its mortality rate has begun to decline with the developments in medicine and is currently around 14% (16). AIm: In the present study, we evaluated the association of the Glasgow Coma Scale (GCS) score and amount of blood loss with mortality in patients presenting with traumatic acute subdural hematoma (ASDH). mATERIAl and mEThODS: This retrospective study was performed on 99 patients who were operated for traumatic acute subdural hematoma (ASDH) without any systemic association at a single center. Epidural hematoma was reported to be the most common additional pathology. Age, sex, mechanism of trauma, time interval between onset of trauma and admission to the emergency ward, associated problems, thickness of hematoma and Glasgow Coma Scale (GCS) score at the time of admission and on discharge were all studied. RESUlTS: The GCS score was inversely proportional to the thickness of hematoma and interval between onset of trauma and surgery (p<0.05). Although the mortality rate was reported to be high in traffic accidents, the rate was low in patients with head trauma only (p<0.05). The mortality rate was high in patients with associated pathologies (p<0.05). Lost patients were reported to be older patients with more extensive ASDH or those who presented earlier with a low GCS (p<0.05). CONClUSION: ASDH is associated with high mortality. GCS score and the thickness of the ASDH are important predictors of mortality. Age, additional trauma, and interval between trauma and hospital admission are major predictive factors for mortality.
Hemispheric differences in the surgical outcomes of patients with traumatic acute subdural hematoma
Journal of negative results in biomedicine, 2014
Our assumption that prognosis of patients with traumatic acute subdural hematoma (ASDH) does not differ significantly according to the hemispheric laterality has never been verified. A review of the charts/radiographic images of 61 adult traumatic ASDH patients (33 left/28 right) was conducted. Intergroup comparison was made on the demographics, autonomic/laboratory data, and outcomes (90-day mortality rate). Based on the presence of concomitant brain contusion, patients were further quadrichotomized as: left ASDH with contusion (n = 14), right ASDH with contusion (n = 16), left ASDH without contusion (n = 19), and right ASDH without contusion (n = 12). Comparisons were made on demographic and outcome variables between the left ASDH with contusion and right ASDH with contusion, and between the left ASDH without contusion and right ASDH without contusion. Multivariate regression analysis was conducted to identify clinical variables correlated with fatality. There were no significant ...
Retrospective Analysis of Operative Treatment of a Series of 100 Patients With Subdural Hematoma
Neurologia medico-chirurgica, 2013
This retrospective study of medical records, surgical protocols, patient observation cards, and imaging files of 100 patients treated for subdural hematoma analyzed the type of hematoma, patient age and sex, operative technique, neurological status, cause of injury, duration of hospital stay, mortality rate, and the number of and reasons for reoperations to determine the effects on treatment outcomes. The time between the head injury and onset of neurological symptoms was analyzed versus the type of hematoma determined from computed tomography (CT) scans. Acute hematomas accounted for 38% of the cases, with subacute hematomas representing 20%, and chronic ones accounting for 42%. In trauma patients, the mean time interval between the injury and onset of neurological symptoms was 0.38 days for acute hematomas, 13.8 days for subacute hematomas, and 23.75 days for chronic hematomas. Repeat surgery was carried out in 26% of the cases. Improvement was obtained in 44% of cases, deterioration in 20%, and no change in neurological status in 36%. Timing of the operations was between 15:00 and 23:00 in 45%, between 23:00 and 7:00 in 33%, and between 7:00 and 15:00 in 22%. The classification of hematomas based on CT presentation corresponds to the classification based on the time elapsed between injury and onset of symptoms, and appears to be appropriate and useful in everyday practice. No preceding injury was identified in 31.6% of acute hematomas, 50% of subacute hematomas, and 61.9% of chronic hematomas. Analysis of reoperations indicates that trepanation may be superior to craniotomy as primary surgery for subacute and chronic hematomas. Subdural hematoma surgeries take place at all times of the day, with most carried out outside the usual working hours.