A prospective study of the time to evacuate acute subdural and extradural haematomas*

Abstract

Summary We performed a prospective, single‐centre study of times to treatment of patients with life‐threatening, traumatic, extra‐ and subdural haematomas requiring surgical evacuation between May 2006 and May 2007. The mean time to surgical decompression was 5.0 h and 32% were performed within 4 h. Patients who initially presented to a district hospital and required transfer for neurosurgery were decompressed in 5.4 h vs 3.7 h for those admitted directly. The current standard of surgical evacuation of all haematomas within 4 h is not being met. Delays were identified in every stage in the management of these patients and no single step was identified as the major cause. Initial treatment in district hospitals led to delays greater than the added driving time. There may be time savings from carrying out treatment steps in parallel instead of in series.

Preoperative trepanation and drainage for acute subdural hematoma: Two case reports

“…A number of studies have demonstrated that the timing of surgical intervention is a major determinant of the outcome of subdural hematoma treatment (4,9). The recommended timing for evacuation of a hematoma is within 4 h of onset; delays past this critical window of time are associated with neuronal loss and poorer outcomes in a number of neurological conditions, including subdural hematomas and strokes (4,10).…”

Editorial: Acute subdural hematoma

“…3,4 In another recent study of the timing of surgical intervention for acute SDH, the mean time to commencement of surgery was 5 hours and only 32% of the cases were started within 4 hours. 1 In another recent study, the median time to emergency surgical intervention for acute SDH was 6 hours, and much of the time spent from injury to operative intervention was attributable to transport time. 2 However, in this same study, the average time from arrival at the neurosurgical center with an acute SDH to the operating room was 0.75 hours, and more than one-quarter of the patients took longer than 1 hour to reach the operating room after arrival at the neurosurgical center.…”

Major Traumatic Brain Injury: Time to Tertiary Care and the Impact of a Clinical Guideline

“…[15][16][17] On average, although we had previously established that most patients could, in theory, arrive at tertiary care within 3 hours, time elapsed before arrival at the neurosurgical center from the urban area and in rural regions during the postimplementation period was 4 hours 51 minutes and 4 hours 40 minutes, respectively. Given the rather dismal results of guideline compliance, most recently only 16% in our study, we wonder whether it is time to institute an alternative prehospitalization management plan, one focused on direct transport to neurosurgical care.…”

“…15 However, differences in patient survival between direct and indirect transfers are not accounted for solely by differences in transport time; in fact, the importance of being directly admitted to a tertiary center is thought to overshadow the importance of overall time to care for mortality. 19 The level of care en route to definitive care plays a role that is at least as important as the time elapsed before receiving care, 28 and it may be more advantageous for a patient with a major head injury to be in an ambulance with highly skilled staff rather than at a lower level trauma center.…”

“…In an effort to streamline the management of major head injury patients and optimize their transfer to tertiary care, the Nova Scotia Head Injury Guideline was devised for use in all 38 emergency departments throughout the Province and was implemented in 2002. 2 Development of the Nova Scotia Head Injury Guideline has been previously published 2 and is shown in Figure 1, outlining the approach for the emergency department management of adult major (Glasgow Coma Scale score [GCS], [3][4][5][6][7][8][9][10][11][12] and minor head injury (GCS score, [13][14][15], and pediatric head injury. In the case of major head injuries in adults, the Guideline directs users to perform intubation if the GCS score is Յ8, or if the GCS score is deteriorating (oxygen mask if GCS score is 9 -12), immobilize the spine, and do a 2-minute focused neurologic assessment.…”