Acute subdural hematoma: Outcome and outcome prediction

Koç, Rahmi Kemal; Akdemir, Hidayet; Oktem, Ibrahim; Meral, Mehmet; Menkü, Ahmet

doi:10.1007/bf01105894

Cited by 136 publications

(50 citation statements)

References 25 publications

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“…3 These data, published in 1981, suggested that faster times to surgery could significantly decrease mortality. Although a few other reports have corroborated this finding 4,5 , a number of subsequent studies have failed to find a similar effect of time to surgery on mortality, even with up to a 10 hour interval 6–9 . In fact, some studies have even reported a significant association between faster times to surgery and increased mortality rates 10–12 .…”

Section: Introductionmentioning

confidence: 85%

Time interval to surgery and outcomes following the surgical treatment of acute traumatic subdural hematoma

Walcott¹,

Khanna²,

Kwon

et al. 2014

Journal of Clinical Neuroscience

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Although the pre-surgical management of patients with acute traumatic subdural hematoma prioritizes rapid transport to the operating room, there is conflicting evidence regarding the importance of time interval from injury to surgery with regards to outcomes. We sought to determine the association of surgical timing with outcomes for subdural hematoma. A retrospective review was performed of 522 consecutive patients admitted to a single center from 2006–2012 who underwent emergent craniectomy for acute subdural hematoma. After excluding patients with unknown time of injury, penetrating trauma, concurrent cerebrovascular injury, epidural hematoma, or intraparenchymal hemorrhage greater than 30 mL, there remained 45 patients identified for analysis. Using a multiple regression model, we examined the effect of surgical timing, in addition to other variables on in-hospital mortality (primary outcome), as well as the need for tracheostomy or gastrostomy (secondary outcome). We found that increasing injury severity score (odds ratio [OR] 1.146; 95% confidence interval [CI] 1.035–1.270; p = 0.009) and age (OR1.066; 95%CI 1.006–1.129; p = 0.031) were associated with in-hospital mortality in multivariate analysis. In this model, increasing time to surgery was not associated with mortality, and in fact had a significant effect in decreasing mortality (OR 0.984; 95%CI 0.971–0.997; p = 0.018). Premorbid aspirin use was associated with a paradoxical decrease in mortality (OR 0.019; 95%CI 0.001–0.392; p = 0.010). In this patient sample, shorter time interval from injury to surgery was not associated with better outcomes. While there are potential confounding factors, these findings support the evaluation of rigorous preoperative resuscitation as a priority in future study.

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Section: Introductionmentioning

confidence: 85%

Time interval to surgery and outcomes following the surgical treatment of acute traumatic subdural hematoma

Walcott¹,

Khanna²,

Kwon

et al. 2014

Journal of Clinical Neuroscience

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“…1,2,13,14) A talk and deteriorate have been described in 6% of patients with GCS score of 3–15 15) or 13% of patients with GCS score of 3–8, 16) excluding prehospital deterioration. Mortality in patients with GCS score of 3–15 has been ranged from approximately 30–60%, 2,15,17,18) or with GCS score of 8 or less as 55–70%. 5,6,12,19,20) …”

Section: Epidemiological Overviewmentioning

confidence: 99%

“…51) Actually, most studies focusing on the time between injury and surgery have failed to demonstrate a correlation with outcome. 1,2,10,12,18,54) …”

Section: Surgical Aspectsmentioning

confidence: 99%

Surgical Management of Traumatic Acute Subdural Hematoma in Adults: A Review

Karibe

Hayashi

Hirano

et al. 2014

Neurol. Med. Chir.(Tokyo)

140

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Traumatic acute subdural hematoma (ASDH) is a major clinical entity in traumatic brain injury (TBI). It acts as a space occupying lesion to increase intracranial pressure, and is often complicated by co-existing lesions, and is modified by cerebral blood flow (CBF) changes, coagulopathy, and delayed hematomas. Because of its complicated pathophysiology, the mortality of ASDH is still remaining high. In this review article, its epidemiology, pathophyiology, surgical treatment, and salvage ability are described. With regard to epidemiology, as the population ages, growing number of elderly patients with ASDH, especially patients with prehospital anticoagulant and antiplatelets, increase. Concerning pathophysiology, in addition to well-known initial intracranial hypertension and subsequent ischemia, delayed hyperemia/hyperperfusion, or delayed hematoma is being recognized frequently in recent years. However, optimal treatments for these delayed phenomenons have not been established yet. With regard to surgical procedures, all of craniotomy, decompressive craniectomy, and initial trephination strategies seem to be effective, but superiority of each procedure have not been established yet. Since Glasgow Coma Scale (GCS) scores, age, papillary reaction, and computed tomographic findings are strongly correlated to outcome, each factor has been investigated as an indicator of salvage ability. None of them, however, has been defined as such one. In future studies, epidemiological changes as population ages, management of delayed pathophysiology, superiority of each surgical procedures, and salvage ability should be addressed.

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Section: Non-english Abstracts Translated For Reviewmentioning

confidence: 99%

“…26 Unequal pupil size (anisocoria) and unequal response to light stimuli in 1 or both pupils may be indicative of transtentorial herniation, which is associated with an 80% to 97% mortality rate. 26,27 There is a lack of published literature on the systematic evaluation of these additional clinical signs in an athletic population to determine their significance in differentiating concussion and other intracranial injury. Suggestions have been made regarding clinical signs and symptoms to be evaluated in cases of suspected intracranial injury, 3 and there is no moderate evidence that current head-injury-management protocols for concussed athletes should be modified to include these specific clinical signs.…”

Section: Non-english Abstracts Translated For Reviewmentioning

confidence: 99%

Differentiating Concussion From Intracranial Pathology in Athletes

Cripps¹,

Livingston²

2017

Journal of Sport Rehabilitation

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Clinical Scenario: A cerebral concussion is a traumatically induced transient disturbance of brain function characterized by a complex pathophysiologic process and is classified as a subset of mild traumatic brain injury. The occurrence of intracranial lesions after sport-related head injury is relatively uncommon, but the possibility of serious intracranial injury (ICI) should be included in the differential diagnosis. ICIs are potentially life threatening and necessitate urgent medical management; therefore, prompt recognition and evaluation are critical to proper medical management. One of the primary objectives of the initial evaluation is to determine if the concussed athlete has an acute traumatic ICI. Athletic trainers must be able promptly recognize clinical signs and symptoms that will enable them to accurately differentiate between a concussion (ie, a closed head injury not associated with significant ICI) and an ICI. The identification of predictors of intracranial lesions is, however, relatively broad. Clinical ScenarioA cerebral concussion is a traumatically induced transient disturbance of brain function characterized by a complex pathophysiologic process and is classified as a subset of mild traumatic brain injury. 1 The occurrence of intracranial lesions after sport-related head injury is relatively uncommon, 2 but the possibility of serious intracranial injury (ICI) should be included in the differential diagnosis. ICIs are potentially life threatening and necessitate urgent medical management; therefore, prompt recognition and evaluation are critical to proper medical management. One of the primary objective of the initial evaluation is to determine if the concussed athlete has an acute traumatic ICI. 3 Athletic trainers must be able promptly recognize clinical signs and symptoms that will enable them to accurately differentiate between a concussion (ie, a closed head injury not associated with significant ICI) and an ICI. The identification of predictors of intracranial lesions is, however, relatively broad. 4 Focused Clinical QuestionWhich clinical examination findings (ie, clinical signs and symptoms) indicate possible intracranial pathology in individuals with acute closed head injuries?

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Acute subdural hematoma: Outcome and outcome prediction

Cited by 136 publications

References 25 publications

Time interval to surgery and outcomes following the surgical treatment of acute traumatic subdural hematoma

Time interval to surgery and outcomes following the surgical treatment of acute traumatic subdural hematoma

Surgical Management of Traumatic Acute Subdural Hematoma in Adults: A Review

Differentiating Concussion From Intracranial Pathology in Athletes

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