Analysis of traumatic acute subdural hematomas: outcomes and predictive factors in a single center experience

Alagöz, Fatíh; Yıldırım, Ali Erdem; Şahinoğlu, Mert; Korkmaz, Murat; Seçer, Mehmet; Çelik, Haydar; Yel, Cihat; Güvenç, Yahya; Uçkun, Özhan Merzuk; Narin, Fırat; Dağlıoğlu, Ergün; Belen, Ahmet Deniz

doi:10.5137/1019-5149.jtn.15177-15.2

Cited by 25 publications

(43 citation statements)

References 9 publications

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“…Many studies stated that the outcome of severe head injury patients with ASDH was mostly poor but with a percentage of a good outcome [3,4,[7][8][9]. These studies stated the overall outcome of all the severe head injury patients without subgrouping analysis.…”

Section: Discussionmentioning

confidence: 99%

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Prognosis of acute subdural hematoma greater than 10 mm in thickness in head injury patients with an extension or no motor response to pain after resuscitation

AbdelFatah

2019

Egypt J Neurosurg

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Background: Most of the studies that examined the prognosis of acute subdural hematoma (ASDH) in severe head injury patients stated their overall prognosis as one group. The aim of the present study was to assess the prognosis of ASDH of > 10 mm in thickness in head injury patients with an extension or no motor response to pain after resuscitation. Material and methods: This retrospective study reviewed the severe head injury patients admitted to our university hospitals from January 2014 to August 2017. The inclusion criteria were the patients with an extension or no motor response to pain after resuscitation with an ASDH > 10 mm in thickness and a midline shift > 5 mm in the initial head computed tomography (CT) scan. Two hundred six patients met the inclusion criteria of this study. Their mean age was 42.3 years. One hundred forty-two patients (68.9%) were males. Results: The mean duration between trauma and admission was 41 min. Sixty-two patients (30%), including 38 anonymous patients, were surgically managed and the remainder were managed conservatively. All patients (100%) died in the intensive care unit within 1 month after trauma. Conclusion: This study emphasized that both surgical and conservative management of ASDH had similar dismal results and that there was no additional benefit from surgical intervention in the studied group of head injury patients. Randomized controlled trials are needed to set a standard of care for the management of ASDH in this subgroup of the severe head injury patients.

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Section: Discussionmentioning

confidence: 99%

“…Generally, traumatic acute subdural hematoma (ASDH) results in high mortality despite intensive treatment [1,2]. It is commonly associated with brain edema, subarachnoid hemorrhage, brain contusions, and diffuse axonal injury, and all affect the neurological outcome [3,4].…”

Section: Introductionmentioning

confidence: 99%

Prognosis of acute subdural hematoma greater than 10 mm in thickness in head injury patients with an extension or no motor response to pain after resuscitation

AbdelFatah

2019

Egypt J Neurosurg

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“…[7] Previous studies have reported that the mortality rate was higher in patients with ASDH with lower Glasgow Coma Scale (GCS) scores, a greater hematoma thickness, an excessive midline shift, and in those who were younger. [1,[8][9][10] Furthermore, some studies indicate a higher mortality rate in patients with additional traumatic lesions, particularly in those having experienced out-of-vehicle traffic accidents. [8,11,12] Although DC has become more popular in recent years, its use has not been generally accepted yet.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Mortality in Acute Subdural Hematoma: Is Decompressive Craniectomy Effective?

Yılmaz

Ertem

Kılıç

et al. 2018

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Despite rapid diagnosis and aggressive neurosurgical intervention, acute subdural hematoma (ASDH) is a severe type of head injury that can result in high morbidity and mortality. Although surgical procedures, such as craniotomy and decompressive craniectomy (DC), can be effective, the preferred approach for treating an ASDH remains controversial. The aim of this report was to evaluate factors associated with mortality in patients with ASDH and determinants of outcome in those with ASDH who underwent DC. METHODS: The demographic details and clinical and radiological characteristics of a total of 93 patients with ASDH who underwent DC during a 60-month period from 2012 to 2017 were evaluated to determine the effect on mortality and any association with the Glasgow Coma Scale (GCS) score recorded on arrival. RESULTS: Sixty-five male and 28 female subjects with a mean age of 59.82±19.49 years (range: 16-88 years) were included in the study. Sixteen patients (17.2%) died following the surgery. Older age (p=0.007) and lower GCS scores (p=0.022) were statistically significantly associated with the mortality rate. The mean hematoma thickness was 15.46±5.73 mm, and the mean midline shift was 9.90±4.84 mm. The mortality rate was positively correlated with an excessive midline shift (p=0.011; r=0.262) and age (p=0.022; r=0.237) in patients with ADSH. A midline shift of ≥10 mm and a hematoma thickness of ≥15 mm was significantly associated with mortality (p=0.014; p=0.039). The etiology of the trauma; comorbidities of subarachnoid, epidural, or intracranial hemorrhage; compression fractures; or contusions were not significantly correlated. CONCLUSION: The results indicated that there was a higher mortality rate among older patients and those with a GCS score of <6 on arrival. A midline shift of ≥10 mm and a hematoma thickness of ≥15 mm were significantly related to mortality. Our study supports the conclusion that DC may help prevent further midline shift and be associated with a lower mortality rate compared with a craniotomy.

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“…Acute subdural hematoma (ASDH) is a major clinical entity in traumatic brain injury (TBI) and is diagnosed by computed tomography (CT) as a hyperdense, extra-axial, crescent lesion between the dura and brain parenchyma 1) . The acceleration-deceleration force applied during traumatic insults can result in stretching and tearing of the cross-linking blood vessels and cortical arteries, which is the source of hematoma formation [2][3][4][5] .…”

Section: Introductionmentioning

confidence: 99%

“…The pressure imposed on the cerebral tissue by a hematoma is not the only factor that affects neurological outcomes, because ASDH is commonly associated with brain edema, contusions, and diffuse axonal injury (DAI) 1,6,7) . This can increase midline shift (MLS) and make hematoma removal inappropriate for satisfactory patient outcomes 8,9) .…”

Section: Introductionmentioning

confidence: 99%

Risk Stratification in Patients with Severe Traumatic Acute Subdural Hematoma

Lee

Song

Choe

et al. 2017

Nerve

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The aim of this study was to investigate risk grouping for surgical outcome in patients with severe traumatic acute subdural hematoma (ASDH). Methods: Seventy-five patients showing low Glasgow Coma Scale (GCS) 3 to 8 were enrolled in this retrospective study. Clinico-radiologic findings were retrieved from electronic medical record and computed tomography. Prognostic factors from univariate and multivariate statistical methodology were included in a recursive partitioning analysis for risk stratification. Results: One month after surgery, 54 patients (72%) had poor Glasgow Outcome Scale (GOS) 1 to 2 (unfavorable outcome). The surgical outcomes were stratified into three homogenous risk groups according to preoperative GCS and presence of basal cistern obliteration. The rate of favorable outcome and mortality significantly differ between the groups: 4.9% and 68.3% in patients with GCS 3 to 5, 23.1% and 53.8% in patients with GCS 6 to 8 and basal cistern obliteration, and 76.2% and 0% in patients with GCS 6 to 8 and without basal cistern obliteration. Conclusion: The surgical outcomes of severe traumatic ASDH patients could be stratified preoperative GCS score and the presence of basal cistern obliteration. It is expected that this model will not only provide objective information when we make decisions about treatment, but it can also be a useful tool when discussing the patient's prognosis with the patient's caregivers.

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Analysis of traumatic acute subdural hematomas: outcomes and predictive factors in a single center experience

Abstract: ASDH is associated with high mortality. GCS score and the thickness of the ASDH are important predictors of mortality. Age, additional trauma, and interval between trauma and hospital admission are major predictive factors for mortality.

Cited by 25 publications

References 9 publications

Prognosis of acute subdural hematoma greater than 10 mm in thickness in head injury patients with an extension or no motor response to pain after resuscitation

Prognosis of acute subdural hematoma greater than 10 mm in thickness in head injury patients with an extension or no motor response to pain after resuscitation

Factors Associated with Mortality in Acute Subdural Hematoma: Is Decompressive Craniectomy Effective?

Risk Stratification in Patients with Severe Traumatic Acute Subdural Hematoma

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