2020 Volume 43 Issue 2 Pages 47-51
Background: The aim of this study was to determine the risk factors for hematoma progression following conservative treatment of traumatic acute subdural hematoma (ASDH).
Methods: A total of 82 ASDH patients treated conservatively over an 8–year period were retrospectively reviewed. Overall, 14 patients (17%) showed hematoma enlargement in the subacute to chronic period. The remaining 68 patients (83%) demonstrated hematoma resolution. Various factors were compared between the two groups.
Results: There were no significant differences in age, sex, Glasgow Coma Scale on admission, prior use of antithrombotic agents, treatment with tranexamic acid or carbazochrome sodium sulfonate, and the presence of combined cerebral contusion or subarachnoid hemorrhage. The following factors were significantly associated with chronification: initial hematoma thickness (p<0.001) and midline shift (p<0.001). The rate of chronification increased according to initial hematoma thickness, with rates of 0% (0/11 cases, ≤ 3 mm), 11% (5/44 cases, 3.1 – 6 mm), 11% (2/18 cases, 6.1 – 9.9 mm), and 78% (7/9 cases, ≥10 mm). The average interval between injury and surgery was 46 days (≤ 6 mm) and 17 days (≥ 6.1 mm).
Conclusions: Patients with ASDH treated initially by conservative management need to be followed keeping in mind that a thicker hematoma may increase the rate of chronification and shorten the interval of required surgery.
