J Korean Neurotraumatol Soc.  2009 Jun;5(1):1-4. 10.13004/jknts.2009.5.1.1.

Outcome of the Severe Acute Subdural Hematoma

Affiliations
  • 1Department of Neurosurgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, Korea. ksleens@sch.ac.kr

Abstract


OBJECTIVE
Acute subdural hematoma (ASDH) is one of the worst post-traumatic mass lesions. Early aggressive management may reduce the mortality rate, while it may cause unbearable sequelae or disabilities. Traditionally a surgical decision is made by the surgeon on the critical victim without delay. However, it is necessary to inform the relatives or family not only the possibility of survival, but also the quality of life after surgery, especially for the comatose victims with ASDHs. We investigate the outcome of the comatose (Glascow coma scale 3-8) patients with ASDH.
METHODS
From January 2005 to December 2006, we managed 141 patients with ASDH. In 52 patients, their initial Glasgow coma score (GCS) was 3-8. We examined the age, initial GCS, size and reflex of pupils, method of treatment, and the outcome at discharge. We also investigated the amount the hematoma, degree of midline shift, and status of the basal cisterns in computed tomographic scans. Statistical significance was tested using the chi-square test. It was considered significant, when p<0.05.
RESULTS
The overall outcome was poor; death in 29, vegetative in 12, severe disability in 10, and moderate disability in 1. There was no good recovery, at all. The outcome was dependent on the initial GCS and pupil. The outcome was independent on the age, amount of the hematoma, degree of midline shift, and method of treatment. However, the age was the only significant factor in deciding not to operate.
CONCLUSION
In severe head injuries, even though we could save the life, the quality of life is too poor to bother not only the victims, but also their family and society. In this situation, it is never sufficient to explain that an immediate surgery is the only way to save the life. We should provide the information on the outcome of the severe head injuries after surgery.

Keyword

Acute subdural hematoma; Craniocerebral trauma; Decision making; Treatment outcome

MeSH Terms

Coma
Craniocerebral Trauma
Decision Making
Hematoma
Hematoma, Subdural, Acute
Humans
Pupil
Quality of Life
Reflex
Treatment Outcome
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