Factors influencing the outcome in acute subdural haematoma

Klun, B.; Fettich, M.

doi:10.1007/bf01401312

Cited by 38 publications

(16 citation statements)

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“…All the eight patients with GCS greater or equal to 13 had a complete recovery. Klun and Fettich [13] and Haselberg et al [9] observed the same correlation. Wilberger et al [23] found statistical significance at the GCS 3 and 4.…”

Section: Discussionsupporting

confidence: 51%

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One hundred and twenty-seven cases of acute subdural haematoma operated on

et al. 1996

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Traumatic acute subdural haematoma is one of the most lethal of all head injuries: the mortality rate is reported to be between 50 and 90%. We reviewed the clinical records of 1688 head injured patients admitted to the Department of Neurosurgery at C.T.O. hospital between 1982 and 1992. In 127 cases (7,5%) CTscan on admission showed acute subdural haematoma requiring surgery because the midline shift was greater than 5 mm. The overall mortality rate was 57% and 23% had functional recovery. The following variables were assessed with regard to morbidity and mortality: mechanism of injury, age, neurological presentation, time delay from injury to intervention, CTscan finding on admission. GCS and CTscan findings were found to be the most important prognostic variable. Timing of operative intervention for clot removal with regard to outcome was not statistically significant. But no conclusions regarding the importance of early haematoma evacuation can be drawn from such an oversimplifying statement, because it does not take into account factors like rapidity of haematoma development and related brain decompensation as well as additional direct brain lesions. The results of this study suggest that the extent of primary brain injury underlying the subdural haematoma is the most important factor affecting outcome.

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Section: Discussionsupporting

confidence: 51%

“…In 127 cases (7,5%) CTscan on admission showed acute subdural haematoma requiring surgery because the midline shift was greater than 5 ram. Subdural haematomas have been considered acute when requiring evacuation within 72 hours of trauma [11,13].…”

Section: Criteria For Patient Selectionmentioning

confidence: 99%

One hundred and twenty-seven cases of acute subdural haematoma operated on

et al. 1996

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“…Many authors reported that patients with bilateral fixed pupils at surgery had favorable outcome from 0 to 13% and a mortality rate from 64 to 93% 11,23,27,32,37) . In case of one non-reacting pupil, favorable outcomes were 25 to 31% and mortality from 48 to 68% 16,33) . This finding was confirmed by another report 10) where the presence of anisocoria did not adversely affect the outcome unless it was associated with decerebrated rigidity or respiratory depression.…”

Section: Discussionmentioning

confidence: 99%

“…Many authors reported that there is highly significant correlation between outcome and GCS score at admission 10,16,18,23) . Patients scoring GCS 3 at treatment have a mortality from 90 to 100% with favorable outcomes of 0 to 5%.…”

Section: Discussionmentioning

confidence: 99%

Predictors for Functional Recovery and Mortality of Surgically Treated Traumatic Acute Subdural Hematomas in 256 Patients

Kim

2009

J Korean Neurosurg Soc

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Objective : The purpose of this study was to investigate the reliable factors influencing the surgical outcome of the patients with traumatic acute subdural hematoma (ASDH) and to improve the functional outcome of these patients. Methods : A total of 256 consecutive patients who underwent surgical intervention for traumatic ASDH between March 1998 and March 2008 were reviewed. We evaluated the influence of perioperative variables on functional recovery and mortality using multivariate logistic regression analysis. Results : Functional recovery was achieved in 42.2% of patients and the overall mortality was 39.8%. Age (OR=4.91, p=0.002), mechanism of injury (OR=3.66, p=0.003), pupillary abnormality (OR=3.73, p=0.003), GCS score on admission (OR=5.64, p=0.000), and intraoperative acute brain swelling (ABS) (OR=3.71, p=0.009) were independent predictors for functional recovery. And preoperative pupillary abnormality (OR=2.60, p=0.023), GCS score (OR=4.66, p=0.000), and intraoperative ABS (OR=4.16, p=0.001) were independent predictors for mortality. Midline shift, thickness and volume of hematoma, type of surgery, and time to surgery showed no independent association with functional recovery, although these variables were correlated with functional recovery in univariate analyses. Conclusion : Functional recovery was more likely to be achieved in patients who were under 40 years of age, victims of motor vehicle collision and having preoperative reactive pupils, higher GCS score and the absence of ABS during surgery. These results would be helpful for neurosurgeon to improve outcomes from traumatic acute subdural hematomas.

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“…De nombreux auteurs ont signalé qu'il existe une corrélation hautement significative entre le résultat et le score GCS à l'admission (HASELSBERGER, 1988 ;KLUN, 1984 ; KOC,1997.…”

Section: Discussionunclassified

Hématomes Extraduraux Chez L’adulte Au Togo

Békéti

James

Gnadi-Piou

et al. 2018

ESJ

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Purpose: The purpose of this work was to evaluate our neurosurgical practice about extradural hematoma and to describe their prognosis in our context. Patients and methods: This is a retrospective study of patients treated for extradural hematoma at Sylvanus Olympio university teaching hospital, which houses the only neurosurgery unit in Togo between April 2008 and August 2014. We included in our study, the files of patients of both sexes, aged over 15 years, with extradural hematoma isolated or not at the cerebral scanner, treated during the study period. Thus, 62 patients were taken into account. There was a male predominance (sex ratio of 19.7). The average age was 29.8 years with extremes of 02 and 70 years of which 41.9% of patients were between 20 and 29 years old. The surgical technique was the making of a burr hole or a cranial flap. We examined the parameters related to surgical treatment and the evolutionary mode. Results: In this study, 34 patients (54.8%) underwent surgery: cranial section (27 cases), widened hole craniotomy (07 cases). The average time between trauma and surgery was 09 days with extremes of 01 to 30 days. Twenty-four patients were operated more than 48 hours after diagnosis and the average postoperative follow-up time was 11.1 days with extremes of 07 and 18 days.European Scientific Journal February 2018 edition Vol.14, No.6 ISSN: 1857 -7881 (Print) e -ISSN 1857-7431 230Twenty-eight patients (45.2%) were not operated on. Among them, 20 patients presented with a HED blade (thickness of less than 10mm) and the eight (08) others for lack of financial means. The average hospital follow-up time for non-operated patients was 15.4 days with extremes of 08 and 60 days. The evolution was evaluated by the Glasgow Outcome Scale over three months. Fifty-five patients or 88.7% recovered without sequel. We obtained 3 cases (4.8%) of deaths including 2 cases that were not operated due to lack of financial means. Conclusion: We have observed that a low Glasgow admission score, long treatment delays, and associated lesions are factors that appear to reduce the prognosis in the treatment of extradural hematoma in Togo. These prognostic factors must be better documented in our future studies to identify them in order to act on them in order to reduce the morbidity and mortality that these extra-mural hematoma cause in our environments. 231 soit 88,7 % ont récupéré sans séquelles. Nous avons obtenu 3 cas (4,8%) de décès dont 2 cas qui n'ont pas été opérés par manque de moyens financiers. Conclusion : Nous avons observé qu'un score de Glasgow bas à l'admission, les délais de prise en charge longs et les lésions associées sont des facteurs qui semblent dégrader le pronostic dans le traitement des hématomes extraduraux au Togo. Ces facteurs pronostiques doivent être mieux documentés dans nos futures études afin de les identifier afin d'agir sur eux dans le but de réduire la morbi-mortalité que ces hématomes extraduraux occasionnent dans nos milieux. Keywords

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Factors influencing the outcome in acute subdural haematoma

Cited by 38 publications

References 11 publications

One hundred and twenty-seven cases of acute subdural haematoma operated on

One hundred and twenty-seven cases of acute subdural haematoma operated on

Predictors for Functional Recovery and Mortality of Surgically Treated Traumatic Acute Subdural Hematomas in 256 Patients

Hématomes Extraduraux Chez L’adulte Au Togo

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