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

Abstract

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.

Prognostic Factors for Decompressive Hemicraniectomy in Severe Traumatic Brain Injury Patients with Traumatic Mass Lesions: A Prospective Experience from a Developing Country

“…34 DC has been shown to prevent brain damage, neurological worsening, and acute oedema following infarctions in patients with traumatic mass lesions. 35 All our patients underwent DC within 48 hours, and it is known that early DC within 48 hours has better neurological recovery and functional outcomes. [36][37][38] Additional factors concerning postoperative care shown to increase the risk of poor outcomes significantly include hypoxia, maintenance of cerebral perfusion pressure, and blood pressure when controlling for other important postoperative care covariates.…”

Comparison of Mortality and Glasgow Outcome Scale Extended (GOSE) between Craniotomy and Decompressive Craniectomy in Patients with Traumatic Acute Subdural Hematoma at Sanglah General Hospital, Bali

“…The study is also in line with the conclusion that stated decompressive craniectomy can help prevent further midline shift and is associated with a lower mortality rate in comparison with craniotomy. 17 Research conducted by Phan, et al also mention that craniectomy is associated with poorer post-operative outcomes compared to craniotomy. 18 In a meta-analysis conducted by Mahadewa, et al in 2020, comparing GCS score between craniectomy and craniotomy in patients with traumatic acute subdural hematoma, revealed craniectomy had poorer clinical outcomes with a pooled risk ratio of 1.41 (95% CI: 1.06-1.88; p=0.02).…”

Role of Decompressive Craniectomy in severe Traumatic Brain Injury: An Institutional Experience

“…The topic of craniotomy or craniectomy for traumatic brain injury remains controversial and studies have shown contrasting results. 10,[12][13][14][15] However, the meta-analysis by Kevin Phan et al 10 concluded that when performed for acute subdural hematoma, decompressive craniectomy was found to be associated with a worse clinical outcome as compared to craniotomy.…”

“…1,7 Studies comparing DC with craniotomy in the management of traumatic brain injury have shown conflicting results with some studies finding DC to be associated with a better outcome and others finding DC to be associated with a worse prognosis. 10,[12][13][14][15] The two large decra and resuscip trial comparing DC with standard medical care in patients suffering from severe traumatic brain injury found that DC leads to more unfavorable outcome compared to standard medical management. 2 Making the procedure more controversial is the perception that even if DC reduces mortality it does so only by increasing the number of patients in the vegetative or severely disabled state, thus again putting into question the rationality of the procedure.…”