2016 Volume 26 Issue 3 Pages 208-214
Acute subdural hematoma (ASDH) has a high mortality and poor prognosis despite intensive treatments including surgery. Although some prognostic factors have been reported, predicting outcomes in ASDH patients remains difficult. In traumatic brain injury (TBI), there is a short time window for initial management and the treatment methods are often left to the surgeon’s discretion. It is also important to assess prognostic factors for ASDH to obtain informed consent. Our institution is the only tertiary emergency institution in the district (population 430,000), and all cases of severe TBI come to our department. The aims of this study were to investigate the prognostic factors and complications in ASDH cases in our institution and assess the state of treatment for ASDH in the district.
Two hundred and forty-four operations for ASDH, acute epidural hematoma and cerebral contusion were performed in our department between January 2005 and December 2015. Cases who received craniotomy for ASDH were included in this study. Exclusion criteria included presence of contralateral ASDH or acute epidural hematoma with mass effect, cases who received burr-hole surgery before craniotomy and with a modified Rankin Scale before occurrence of ASDH of ≧3, and children under 6 years of age. Eighty-eight cases were registered and investigated with respect to prognostic factors and complications.
Seventy cases (79.5%) were over 60 years of age. According to the Glasgow Outcome Scale score at discharge, only 22 cases (25.0%) had a favorable outcome composed of ‘good recovery’ and ‘moderate disability’, while 35 cases (39.8%) had complications following surgery. There was a significant correlation of prognostic factors with clinical parameters including Glasgow Coma Scale, pupillary status, hematoma thickness, midline shift, compression of basal cisterns, and presence of cortical subarachnoid hemorrhage. Complications were also related to the outcome of ASDH.
Most cases of ASDH in the district were elderly people, while treatment for severe TBI was only available at our institution. Because many severe cases and elderly people were included this study, only 22 cases (25.0%) had a favorable outcome, while 35 cases (39.8%) had complications following surgery. Glasgow Coma Scale, pupillary status, hematoma thickness, midline shift, compression of basal cisterns, and presence of cortical subarachnoid hemorrhage were prognostic factors for ASDH. The management of complications following surgery is also critical for improved outcomes.
