Prognosis of acute subdural hematoma greater than 10 mm in thickness in head injury patients with an extension or no motor response to pain after resuscitation

Abstract

Background: Most of the studies that examined the prognosis of acute subdural hematoma (ASDH) in severe head injury patients stated their overall prognosis as one group. The aim of the present study was to assess the prognosis of ASDH of > 10 mm in thickness in head injury patients with an extension or no motor response to pain after resuscitation. Material and methods: This retrospective study reviewed the severe head injury patients admitted to our university hospitals from January 2014 to August 2017. The inclusion criteria were the patients with an extension or no motor response to pain after resuscitation with an ASDH > 10 mm in thickness and a midline shift > 5 mm in the initial head computed tomography (CT) scan. Two hundred six patients met the inclusion criteria of this study. Their mean age was 42.3 years. One hundred forty-two patients (68.9%) were males. Results: The mean duration between trauma and admission was 41 min. Sixty-two patients (30%), including 38 anonymous patients, were surgically managed and the remainder were managed conservatively. All patients (100%) died in the intensive care unit within 1 month after trauma. Conclusion: This study emphasized that both surgical and conservative management of ASDH had similar dismal results and that there was no additional benefit from surgical intervention in the studied group of head injury patients. Randomized controlled trials are needed to set a standard of care for the management of ASDH in this subgroup of the severe head injury patients.

Clinical characteristics and functional outcome of surgically treated adult head trauma patients with acute subdural hematoma: Ethiopian tertiary hospitals experience

“…Traffic accidents and fall accidents were the major mechanisms of trauma in patients with ASDH. 12 , 19 However, in our study assault by stick and stone, 41(35.7 %) was a major cause of trauma. Those patients who sustained road traffic accident had a higher number of unfavorable outcome compared to other mechanisms but was not statically significant (chi-square p = 0.187).…”

“… 6 However, in other studies SAH was the most common finding. 7 , 19 In addition, hemorrhagic contusion was found significantly higher in unfavorable outcome group 31(52.5 %) (Chi-square p = 0.044).…”

“…Better than to study done by Abdelfatah et al on the prognosis of ASDH in patients with an extension or no motor response to pain motor response found that all patients died within 1 month. 19 …”

A Validation Study for SHE Score for Acute Subdural Hematoma in the Elderly

“…In general, predictors of poor clinical outcome in elderly patients suffering from aSDH were extensively described [ 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Patients suffering from traumatic aSDH are known to have higher risk of developing SE associated with poor outcome [ 25 , 26 ].…”

“…In a prospective observational study reported by Weimer et al [ 6 ] on a mixed population of 116 patients with SDH, aside from old age, poor premorbid neurological status, admission Glasgow Coma Score (GCS), and history of smoking and fever during hospitalization were independent predictors for poor outcome. There are several series providing scores to predict the outcome in patients with SDH [ 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Apart from the abovementioned well-known outcome predictors, status epilepticus is an unrecognized prognostic factor in patients with surgical interventions for SDH [ 14 , 15 ].…”