Traumatic acute subdural hematoma and coma: retrospective cohort of surgically treated patients

Bocca, Leonardo Favi; Lima, João Vitor Fernandes; Suriano, Ítalo Capraro; Cavalheiro, Sérgio; Rodrigues, Thiago

doi:10.25259/sni_490_2021

Cited by 12 publications

(11 citation statements)

References 25 publications

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“…The small number of females might be misrepresentative of this gender; however, this limitation has been observed in the majority of prior studies. The outcome after TBI might be influenced by patient's comorbidity such as diabetes mellitus, hypertension, dyslipidemia, smoking, chronic obstructive pulmonary disease, and heart disease; however, our data could be unique in terms of patient age in comparison to prior studies from other countries [ 14 – 18 ] as the mean age in our cohort is 34 ± 14 which precludes the presence of high proportion of comorbidities. However, diabetes mellitus and hypertension were found in 11.8%, and multivariate analysis showed that they did not have a significant predictor role for mortality.…”

Section: Discussionmentioning

confidence: 75%

“…This higher rate of acute traumatic SDH among males than females was also reported in many previous studies from different countries. For instance, the proportions of affected males were 52% (Portugal), 53% (Italy and Spain), 64% (Japan), 65% (the USA), and 74% (Brazil) [ 14 – 18 ]. However, there is no reported explanation in the literature for such gender discrepancy.…”

Section: Discussionmentioning

confidence: 99%

“…However, there is no reported explanation in the literature for such gender discrepancy. In traumatic SDH, gender was not influencing the hospital survival [ 15 – 18 ]; however, male gender was associated with a poor functional outcome in one study [ 14 ]. Although in-hospital mortality was comparable by gender, males ≥55 years had a higher mortality rate when compared to young age males in our study.…”

Section: Discussionmentioning

confidence: 99%

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Gender Discrepancy in Patients with Traumatic Brain Injury: A Retrospective Study from a Level 1 Trauma Center

El‐Menyar

Mekkodathil

Verma

et al. 2022

BioMed Research International

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Objectives. The objective of this study is to explore the gender discrepancy in patients with traumatic brain injury (TBI). Methods. A retrospective analysis of Qatar Trauma Registry (QTR) was conducted among patients (age ≥14y) who were hospitalized with TBI. Data were collected and analyzed based on the gender and age. Results. Over 5 years (2014-2019), 9, 309 trauma patients (90% males and 10% females) were admitted to the trauma center. Of these, 1, 620 (17.4%) patients were hospitalized with TBI (94% males and 6% females). Motor vehicle crash was the main mechanism of injury (MOI) in females, and fall from height was predominant among males. Subdural hematoma (SDH) was the more frequent type of TBI in both genders, but it was more prevalent in male patients ≥55 years. Injury severity score, Glasgow coma scale, and head abbreviated injury score were comparable between males and females. The length of stay in the ICU and hospital and mortality were similar in both genders. However, mortality was higher among males ≥55 years when compared to 14-54 years within the same gender (21% vs. 12%, p = 0.002 ). The crude and adjusted odds ratio did not show that gender is a significant predictor of mortality among TBI patients. Conclusions. Although the incidence and MOI of TBI show significant differences between male and female patients, the severity and outcomes are comparable.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Gender Discrepancy in Patients with Traumatic Brain Injury: A Retrospective Study from a Level 1 Trauma Center

El‐Menyar

Mekkodathil

Verma

et al. 2022

BioMed Research International

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“…In general, ultra-early surgery was reserved to patients with worse clinical and radiological findings at arrival, which is known to strongly influence the outcome [ 17 , 28 , 29 , 34 ]. Moreover, the clinical and radiological scenarios of the ASDH patients are dynamic and heterogeneous, with a number of patients who will maintain stable conditions and others who will suffer a worsening, which will eventually influence the timing of the surgery and post-operative outcome [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Does the Timing of the Surgery Have a Major Role in Influencing the Outcome in Elders with Acute Subdural Hematomas?

Trevisi

Scerrati

Rustemi

et al. 2022

JPM

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Background: The incidence of traumatic acute subdural hematomas (ASDH) in the elderly is increasing. Despite surgical evacuation, these patients have poor survival and low rate of functional outcome, and surgical timing plays no clear role as a predictor. We investigated whether the timing of surgery had a major role in influencing the outcome in these patients. Methods: We retrospectively retrieved clinical and radiological data of all patients ≥70 years operated on for post-traumatic ASDH in a 3 year period in five Italian hospitals. Patients were divided into three surgical timing groups from hospital arrival: ultra-early (within 6 h); early (6–24 h); and delayed (after 24 h). Outcome was measured at discharge using two endpoints: survival (alive/dead) and functional outcome at the Glasgow Outcome Scale (GOS). Univariate and multivariate predictor models were constructed. Results: We included 136 patients. About 33% died as a result of the consequences of ASDH and among the survivors, only 24% were in good functional outcome at discharge. Surgical timing groups appeared different according to presenting the Glasgow Outcome Scale (GCS), which was on average lower in the ultra-early surgery group, and radiological findings, which appeared worse in the same group. Delayed surgery was more frequent in patients with subacute clinical deterioration. Surgical timing appeared to be neither associated with survival nor with functional outcome, also after stratification for preoperative GCS. Preoperative midline shift was the strongest outcome predictor. Conclusions: An earlier surgery was offered to patients with worse clinical-radiological findings. Additionally, after stratification for GCS, it was not associated with better outcome. Among the radiological markers, preoperative midline shift was the strongest outcome predictor.

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“…Bocca et al in 2021 published a retrospective study regarding patients with acute subdural hematoma who were managed surgically [ 15 ]. Their results were quite alarming as more than half of the patients died and patients who were more than 75 years old had 100% mortality even after surgical management.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors of Outcomes in Acute Subdural Hematoma Evacuation

Manan¹,

Rehman²,

Khan³

et al. 2022

Cureus

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Objective: This comparative cross-sectional study was conducted in the Departments of Trauma and Neurosurgery, Ayub Teaching Hospital, Abbottabad, Pakistan from September 2021 to February 2022 to study predictive factors of outcomes in acute subdural hematoma evacuation.Methodology: A total of 101 patients with confirmed diagnosis of acute subdural hematoma (ASDH) who underwent surgical evacuation by consultant neurosurgeon were included in the study. A detailed clinical proforma was designed to document all the clinical and demographic details of these patients at the time of admission. Glasgow Coma Scale outcome score (GOS) was used to assess the outcome of patients after the surgery. Sociodemographic and clinical parameters were associated with outcome of surgery in our study participants.Results: Out of 101 patients, 55 (54.5%) were males and 46 (45.5%) were females. Mean age was 43.66±19.66 years with 7.39 as mean Glasgow Coma Scale (GCS) at presentation. Road traffic accident (RTA) 62 (61.4%) was most frequent mechanism of injury followed by fall from height (19.8%) and history of assault (13.9%). In our study, 59 patients had poor outcomes while 42 had good outcomes. Elder age, low GCS at presentation, and use of oral anticoagulant were associated with poor outcomes while pupillary reaction had no effect on the outcome after application of test of significance.Conclusion: More than half of the patients managed with surgical evacuation for acute subdural hematoma as per guidelines at our neurosurgical unit had poor outcomes according to Glasgow Coma Scale. In this study, advancing age (>60 years), low GCS score at presentation, and use of oral anticoagulation therapy emerged as significant risk factors for poor outcomes in participants. Pupillary reaction had no effect on outcomes as per this study but this needs further evaluation in future studies.

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Traumatic acute subdural hematoma and coma: retrospective cohort of surgically treated patients

Cited by 12 publications

References 25 publications

Gender Discrepancy in Patients with Traumatic Brain Injury: A Retrospective Study from a Level 1 Trauma Center

Gender Discrepancy in Patients with Traumatic Brain Injury: A Retrospective Study from a Level 1 Trauma Center

Does the Timing of the Surgery Have a Major Role in Influencing the Outcome in Elders with Acute Subdural Hematomas?

Predictive Factors of Outcomes in Acute Subdural Hematoma Evacuation

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