One hundred and twenty-seven cases of acute subdural haematoma operated on

Abstract

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 mm. 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.

Early Glasgow Outcome Scale Scores Predict Long-Term Functional Outcome in Patients with Severe Traumatic Brain Injury

“…In gender and injury severity-matched groups (n ϭ 50 patients each), patients 55 years or older demonstrated significantly longer hospital stays, significantly higher rehabilitation charges, and significantly less improvement on functional outcome scales. Massaro and coworkers documented the poor outcomes associated with acute subdural hematomas in 127 TBI patients (Massaro et al, 1996). The group documented a mortality rate of 57% with a functional recovery rate of 23%.…”

“…The most intense and costly acute care and rehabilitation resources could be concentrated upon those most likely to make a meaningful recovery. Previous investigators have shown the prognostic value of patient characteristics or acute data such as age (Asikainen et al, 1998;Cifu et al, 1996), pupillary abnormalities (Koc et al, 1997), initial Glasgow Coma Score (Cowen et al, 1995;Koc et al, 1997;Massaro et al, 1996;Rae-Grant et al, 1996), evoked potential responses (Rae-Grant et al, 1996), imaging (Massaro et al, 1996), length of hospitalization (Cowen et al, 1995), and length of coma (Asikainen et al, 1998). There has been little work on the use of post-acute data and prognosis for recovery from TBI (Choi et al, 1994).…”

Nonsurgical acute traumatic subdural hematoma: what is the risk?

“…When combining all patients with TBI, 11% present with an SDH. 10 Acute traumatic SDH has been traditionally considered a lesion that should be treated surgically, although some might be approached conservatively. In a study by Wong, 17 a midline shift greater than 5 mm in patients with a Glasgow Coma Scale (GCS) score below 15 was associated with deterioration and the need for surgical evacuation.…”

Predictors of outcomes after nontraumatic subdural hematoma

“…In contrast, Van den Brink et al 13 suggested that the volume of hematoma did not correlate with preoperative clinical status or 6-month outcome and, consequently, is not of additional prognostic value. Massaro et al 14 suggested in their series that GCS score and hematoma size were both important, although this study also reported that timing of operation had little impact on outcome. A detailed review of 40 studies from 1975 to 1996 of patients with severe head injury and coma with acute SDH, however, suggested that all of these possible predictors were important: age; time to operation; pupillary changes; GCS score and, specifically, the motor subscore on admission; absence of a lucid interval; type of operation; and computed tomographic findings including hematoma volume and degree of midline shift.…”