The optimal operative timing of traumatic intracranial acute subdural hematoma correlated with outcome

Abstract

Objective:Acute subdural hematoma (ASDH) has been associated with mortality in traumatic brain injury. The timing of surgical evacuation for ASDH has still been controversial. The object of this study was to determine the temporal and clinical factors associated with outcome following surgery for ASDH.Materials and Methods:The study retrospectively viewed medical records and neuroimaging studies of ASDH patients who underwent surgical evacuation. Surgical outcomes were dichotomized into favorable and unfavorable outcomes, and operative times compared between the groups.Results:The records of 145 ASDH patients who underwent surgery were reviewed. Almost two-thirds of the patients were admitted for surgical evacuation, of whom 71% underwent a decompressive operation. The temporal variables were as follows: mean time from scene of accident to emergency department (ED) was 70 (Standard deviation [SD] 256.0) min, mean time from ED to obtaining CT of the brain was 45.6 (SD 38.9) min, mean time from brain computed tomographic to operating room arrival was 68.6 (SD 50.0) min, and mean time from ED arrival to skin incision was 160.1 (SD 88.1) min. The mean time from ED arrival to skin incision was significantly shorter in the unfavorable outcome group. Because of this reverse association between time from ED to surgery, multivariate analysis was applied to adjust the timing factors with other clinical factors, and the results indicated that temporal factors were not associated with functional outcome, as features such as increased intracranial pressure due to obliterated basal cistern and brain herniation were significantly associated with functional outcome.Conclusions:The optimal times for surgical evacuation of ASDH are challenging to estimate because compressed brainstem signs are more important than time factors. ASDH patients with compressed brainstem should have surgery as soon as possible.

Traumatic Epidural and Subdural Hematoma: Epidemiology, Outcome, and Dating

“…According to the literature, SDHs of a traumatic nature affect men more than women, especially aged <50 years [ 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. Similarly, EDHs are more frequent in men [ 11 , 12 , 13 ].…”

“…SDHs are generally associated with high-energy traumas, especially road accidents [ 4 , 6 , 7 , 8 , 14 , 15 , 16 ]. In contrast, excluding the case study by Zhang et al [ 11 ], EDHs with a clear prevalence of motor vehicle accidents (MVA), showed overlapping percentages of falls and MVAs [ 17 , 18 , 19 ].…”

“…SDHs have a perioperative mortality rate (death occurring within 30 days after surgery) between 11.5 and 67.1% (mean 38.4%, median 38.2%) [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 14 , 15 , 16 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. This wide range is due to the great diversity of the analyzed cohorts; among them, only two studies [ 41 , 42 ] narrowed the mortality between 14% and 33.5%, respectively.…”

“…According to the data, EDHs have favorable outcome—that is to say a GOS at discharge/follow up of 4 or 5 (good recovery and moderate disability)—between 69 and 95% (mean 84.3%, median 88.9%) [ 11 , 12 , 17 , 18 , 19 , 76 , 79 ], whereas the range of SDHs varies between 9 and 76% in the perioperative period (mean 32.1%, median 26.5%) [ 4 , 5 , 6 , 8 , 15 , 16 , 24 , 25 , 26 , 28 , 29 , 33 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 44 , 46 ]. An increase in these percentages is revealed during follow up (variable, according to the single case, from 3 months to 1 year).…”

“…An increase in these percentages is revealed during follow up (variable, according to the single case, from 3 months to 1 year). This increase is mostly due to the functionality recovery of patients with GOS 3 [ 6 , 24 , 26 , 46 ]. Generally, the highest percentages of functionality recovery are found in studies that report only follow up data, without the perioperative data [ 47 , 80 ].…”