Acute Subdural Hematoma

Abstract

We devised a linear discriminant function to predict the outcome for patients with acute subdural hematoma (ASDH) based on a consecutive series of 170 ASDH cases with mild to severe head injury [Glasgow Coma Scale (GCS) 3-15]. Functional recovery was achieved in 50.0% of patients and the mortality was 36.5%. The relationship between initial clinical and radiological signs and the outcome 3 months after admission was studied retrospectively by Mann-Whitney's U-test and Pearson's chi-squared test. Fourteen factors (GCS, pupillary response, motor paresis, age, hematoma volume and thickness, midline shift, association with cerebral contusion and subarachnoid hemorrhage, obliteration of the basal, ambient, or quadrigeminal cistern on computed tomography, fibrin-fibrinogen degradation product level, and intracranial pressure) were found to correlate significantly (p < 0.01) with outcome. Linear discriminant functions were formulated by multivariate analysis to investigate the relationship between these factors and recovery or poor prognosis. The following formula was obtained: Z = -0.110 + 0.013 (Age) - 0.108 (GCS) + 0.397 (Eye) + 0.003 (Shift) + 0.268 (Ambient). Functional recovery could be predicted by a negative Z value, with an accuracy of 90.59%. This simple discriminant function is useful for predicting the outcome of ASDH.

Randomized Comparative Study of Burr-hole Craniostomy Versus Twist Drill Craniostomy; Surgical Management of Unilateral Hemispheric Chronic Subdural Hematomas

“…It was noticeable that all the recurrences occurred in the fi rst month after discharge from hospital and no recurrences occurred in the following 5 months. Some authors claim that BHC is inadequate to treat so-called septated, multi-loculated or multi-layered hematomas and propose a craniectomy-membranectomy [5] or endoscopic surgery in such cases [21] . In our series there were 8 cases of septated hematomas.…”

Predictors of Thirty-day Mortality and Length of Stay in Operative Subdural Hematomas

“…It has been established in the literature that SDHs have a high associated morbidity [2-9]. However, larger collections of retrospective data on this patient population are allowing us to determine variables that make patients with SDHs more likely to have a poor outcome.…”

“…Historically, mortality among patients with traumatic acute SDHs treated surgically is high, with a range of 30%-70% reported [2-9]. More recent studies have demonstrated a 12%-15% mortality rate for SDHs overall [1, 10-11].…”

Craniotomy or Decompressive Craniectomy for Acute Subdural Hematomas: Surgical Selection and Clinical Outcome

“…ASDH are present in approximately one third of patients with severe traumatic brain injury. 22) Despite advances in emergency medical services and surgical techniques, ASDH remains one of the most lethal of all intracranial injuries. Various surgical modality such as simple burr hole trephination, CO, and DC are used for evacuation of ASDH.…”

“…Acute subdural hematomas (ASDH) are observed in one third of patients with severe traumatic brain injury. 22) ASDH forms between the dura and arachnoid membranes usually due to tearing of bridging veins or arterial rupture. Management of ASDH may vary from simple observation to different surgical evacuation technique.…”