Factors Predicting Outcome of Surgically Treated Acute Subdural Hematoma
Keywords:acute subdural hematoma, operative mortality, prognostic factors, GCS: Glasgow coma scale, Glasgow outcome scale (GOS).
Objective: The study aimed to evaluate operative mortality and prognosis factors in posttraumatic acute subdural hematoma patients.
Material & Methods: A prospective cross-sectional study was done in the Department of Neurosurgery, Ayub Teaching Hospital Abbottabad. 82 patients operated for Acute Subdural Hematoma were included in the study. Variables that influence the outcome were recorded. The outcome was measured in terms of mortality.
Results: Of 82 patients operated on, 61 were male, and 21 were female. 51 were <40 old years, 21 were aged 41-60, and 7 were over 60. The most common cause is fall from height (47.6%). Cerebral contusion is often associated (28%). Overall mortality: 39.2%. Male mortality: 29.2%, female: 9.7%. Surgery >4 hours post-injury had higher mortality (18.2%) vs. <4 hours (8.5%). 14/43 GCS <8 patients survived, with no deaths when GCS >12. Pupillary abnormalities had higher mortality (31.9%) vs. normal pupils (7.3%). No deaths with hematoma thickness <10mm and only 1 survived with a thickness >16mm. 25/29 died with midline shift >11mm.
Conclusion: Prognostic factors for surgically treated traumatic acute subdural hematoma include GCS at presentation, pupils, hematoma thickness, midline shift, and time to surgery. Better outcomes associated with GCS>9, normal pupils, hematoma width <1.5cm, midline shift <1cm, and surgery within 4 hours.
Lavrador JP, Teixeira JC, Oliveira E, Simão D, Santos MM, Simas N. Acute Subdural Hematoma Evacuation: Predictive Factors of Outcome. Asian J Neurosurg. 2018;13(3):565-71.
Prahaladu P, Prasad KS, Rajashekar B, Reddy KS. Clinical study of acute subdural haematoma – a level I trauma care centre experience. International Journal of Research in Medical Sciences.2017;5(3): 857-62.
Karibe H, Hayashi T, Hirano T, Kameyama M, Nakagawa A, Tominaga T. Surgical management of traumatic acute subdural hematoma in adults: a review. Neurologiamedicochirurgica. 2014;54(11):887-94.
Marbacher S, Fandino J, Lukes A. Acute subdural hematoma from ruptured cerebral aneurysm. ActaNeurochir (Wien).2010;152(3):501–7.
Howard MA, Gross AS, Dacey RG, Winn HR. Acute subdural hematomas: an agedependent clinical entity. Journal of Neurosurgery. 1989;71(6):858-863.
Alvis-Miranda H, Castellar-Leones SM, Moscote-Salazar LR. Decompressive Craniectomy and Traumatic Brain Injury: A Review. Bull EmergTrauma 2013;1(2):60–8.
Gunjkar J, Vhora SS, Gupta A. Prognostic factors in operated cases of acute subdural hematoma. International Journal of Contemporary Medicine Surgery and Radiology.2019;4(3):C52-C56.
Karibe H, Hayashi T, Hirano T, Kameyama M, Nakagawa A, Tominaga T. Surgical management of traumatic acute subdural hematoma in adults:a review. Neurol Med Chir (Tokyo) 2014;54(11):887–94
Alagoz F, Yildirim AE, Sahinoglu M, Korkmaz M, Secer M, Celik H, et al. Traumatic Acute Subdural Hematomas: Analysis of Outcomes and Predictive Factors at a Single Center. Turk Neurosurg 2017;27(2):187–91
Shen J, Pan JW, Fan ZX, Zhou YQ, Chen Z, Zhan RY. Surgery for contralateral acute epidural hematoma following acute subdural hematoma evacuation: five new cases and a short literature review. ActaNeurochir(Wien) 2014;8(155):335–41.
Y?lmaz ?, Ertem DH, K?l?ç M, Alta? K, Mirhasilova M, Özdemir B, et al. Factors associated with mortality in acute subdural hematoma: Is decompressive craniectomy effective? UlusTravmaAcilCerrahiDerg 2019;25(2):147-153.
Leitgeb J, Mauritz W, Brazinova A, Janciak I, Majdan M, Wilbacher I, et al. Outcome after severe brain trauma due to acute subdural hematoma. JNeurosurg 2012;117(2):324–33
Kaptano?lu E,Solaro?lu I, Uçar MD, Okutan MO, Be?konakli E, Ta?kin Y. Acute subdural hematomas: surgical treatment. Retrospective analysis of 73 case. UlusTravmaDerg 2001;7(4):246–9.
Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GW, Bell MJ, et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery 2017;80(1):6–15
Walcott BP,Khanna A, Kwon CS, Phillips HW, Nahed BV, Coumans JV. Time Interval to Surgery and Outcomes Following the Surgical Treatment of Acute Traumatic Subdural Hematoma. Journal of Clinical Neuroscience.2014;21(12): 2107–11.
Kwon YS, Yang KH, Lee YH. Craniotomy or Decompressive Craniectomy for Acute Subdural Hematomas: Surgical Selection and Clinical Outcome. Korean J Neurotrauma. 2016;12(1):22-27.
Elshanawany AM, Essa AA. Traumatic Acute Subdural Hematoma: Treatment by Evacuation with Decompressive Craniotomy and Cranioplasty, Case Series and Surgical Outcome Analysis. Open J Mod Neurosurg. 2018; 8(3):331-41.
MonsivaisD, Huimahn A Choi, Ryan K, Franch M, Cai C. A retrospective analysis of surgical outcomes for acute subdural hematoma in an elderly cohort. Interdiscip Neurosurg. 2018;14:130-34.
Lavrador JP, Teixeira JC, Oliveira E, Simao D, Santos MM, Simas N. Acute Subdural Hematoma Evacuation: Predictive Factors of Outcome. Asian J Neurosurg. 2018;13(3):565-71.
Lee D, Song SW, Choe WJ, Cho J, Moon CT, Koh YC. Risk Stratification in Patients with Severe Traumatic Acute Subdural Hematoma. The Nerve. 2017;3(2):50-57.
Karnjanasavitree W, Phuenpathom N, Tunthanathip T. The Optimal Operative Timing of Traumatic Intracranial Acute Subdural Hematoma Correlated with Outcome. Asian J Neurosurg. 2018;13(4):1158-64.
Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006;58(Suppl 3):S16-S24.
Seelig JM, Becker DP, Miller JD, Greenberg RP, Ward JD, Choi SC. Traumatic acute subdural hematoma: major mortality reduction in comatose patients treated within four hours. N Engl J Med. 1981;304(25):1511-18.
Altaf I, Shams S, Vohra AH. Role of surgical modality and timing of surgery as clinical outcome predictors following acute subdural hematoma evacuation. Pak J Med Sci. 2020;36(3):412-15.
Elhawary MA, El Shokhaiby UM, Ali WE, Gafar AM, Abd El Rahman AA. Factors affecting the prognosis of traumatic acute subdural hematomas. Sci J Al-Azhar Med Fac Girls. 2019;3(1):246–251.
Igbokwe KK, Ayogu OM, Onobun DE, Essiet EA, Ugwuanyi UC. The Outcomes of Traumatic Acute Subdural Hematoma in a Tertiary Center in Abuja, Nigeria. Cureus. 2021;13(11):e20016.
Prahaladu P, Prasad KS, Rajasekhar B, Reddy KS. Clinical study of acute subdural haematoma – a level I trauma care centre experience. International Journal of Research in Medical Sciences. Int J Res Med Sci. 2017;5(3):857-62.
Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical Management of Traumatic Brain Injury Author Group. Surgical management of acute subdural hematomas. Neurosurgery. 2006;58(3 Suppl):S16-24.
Petridis AK, Dörner L, Doukas A, Eifrig S, Barth H, Mehdorn M. Acute subdural hematoma in the elderly; clinical and CT factors influencing the surgical treatment decision. Cent Eur Neurosurg. 2009;70(2):73-8..
Akbik OS, Starling R, Green R, Zhu Y, Lewis J. Delayed Surgical Intervention in Acute Subdural Hematoma. Cureus. 2020;12(11):e11592.
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