CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2022; 11(02): 128-135
DOI: 10.1055/s-0040-1719201
Original Article

Clinical, Surgical and Outcome Predictive Factor Analysis of Operated Acute Subdural Hematoma Cases: A Retrospective Study of 114 Operated Cases at Tertiary Centre

1   Department of Neurosurgery, Institute of Medical Sciences–Banaras Hindu University (IMS–BHU), Varanasi, India
,
1   Department of Neurosurgery, Institute of Medical Sciences–Banaras Hindu University (IMS–BHU), Varanasi, India
,
1   Department of Neurosurgery, Institute of Medical Sciences–Banaras Hindu University (IMS–BHU), Varanasi, India
,
1   Department of Neurosurgery, Institute of Medical Sciences–Banaras Hindu University (IMS–BHU), Varanasi, India
,
1   Department of Neurosurgery, Institute of Medical Sciences–Banaras Hindu University (IMS–BHU), Varanasi, India
› Author Affiliations
Funding None.

Abstract

Objective To analyze clinical, surgical and outcome predictive factors of operated acute subdural hematoma (SDH) cases for prognostication and surgical outcome prediction.

Material and Methods This retrospective study includes 114 patients operated for acute SDH in the Department of Neurosurgery of IMS BHU, Varanasi, India, a tertiary care center, between 1 August 2018 and 1 November 2019. Each patient was evaluated for age, sex, mode of injury, localization of hematoma, clinical presentation, comorbidity, severity of injury, best motor response, CT findings, and Glasgow outcome scale (GOS) at discharge. The outcome was also evaluated by further making a dichotomized group using GOS in death/dependent (1–3) versus independent (4–5). Statistical tests were done using the GraphPad Prism version 8.3.0.

Results The most common age group operated upon in this study was the 40 to 60 years age group (n = 45, 39.48%). Males were 78% with male to female ratio of 3.56:1. The most common clinical presentation was altered sensorium (98.25%). The most common comorbidity was hypertension (n = 32, 28.07%). GCS at admission, severity of injury, pupillary changes, and best motor response (p < 0.0001) were significantly associated with surgical outcome.

Conclusion GCS at admission, severity of injury, pupillary changes, and best motor response were significantly (p < 0.05) associated with surgical outcome. Age and gender of patients were not found to be significantly associated.



Publication History

Article published online:
25 May 2021

© 2021. Neurological Surgeons’ Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 
  • References

  • 1 Youmans J, Winn H. Youmans & Winn Neurological Surgery. 7th ed.. Philadelphia: Elsevier; 2017
  • 2 Marshall LF, Gautille R, Klauber MR. et al The outcome of severe closed head injury. J Neurosurg 1991; 75 (Suppl. 01) S28-S36
  • 3 Kawamata T, Takeshita M, Kubo O, Izawa M, Kagawa M, Takakura K. Management of intracranial hemorrhage associated with anticoagulant therapy. Surg Neurol 1995; 44 (05) 438-442 , discussion 443
  • 4 Marbacher S, Fandino J, Lukes A. Acute subdural hematoma from ruptured cerebral aneurysm. Acta Neurochir (Wien) 2010; 152 (03) 501-507
  • 5 Seelig JM, Becker DP, Miller JD, Greenberg RP, Ward JD, Choi SC. Traumatic acute subdural hematoma: major mortality reduction in comatose patients treated within four hours. N Engl J Med 1981; 304 (25) 1511-1518
  • 6 Seelig JM, Greenberg RP, Becker DP, Miller JD, Choi SC. Reversible brain-stem dysfunction following acute traumatic subdural hematoma: a clinical and electrophysiological study. J Neurosurg 1981; 55 (04) 516-523
  • 7 Hanif S, Abodunde O, Ali Z, Pidgeon C. Age related outcome in acute subdural haematoma following traumatic head injury. Ir Med J 2009; 102 (08) 255-257
  • 8 Petridis AK, Dörner L, Doukas A, Eifrig S, Barth H, Mehdorn M. Acute subdural hematoma in the elderly; clinical and CT factors influencing the surgical treatment decision. Cent Eur Neurosurg 2009; 70 (02) 73-78
  • 9 Kameyama M, Karibe H, Kawase M, Hayashi T, Hirano T, Tominaga T. Severe head injury and age in Japan Neurotrauma Data Bank: comparison among Project 1998, 2004, 2009. ] Neurotraumatology 2013; 36: 10-16
  • 10 Ryan CG, Thompson RE, Temkin NR, Crane PK, Ellenbogen RG, Elmore JG. Acute traumatic subdural hematoma: current mortality and functional outcomes in adult patients at a Level I trauma center. J Trauma Acute Care Surg 2012; 73 (05) 1348-1354
  • 11 Kotwica Z, Brzeziński J. Acute subdural haematoma in adults: an analysis of outcome in comatose patients. Acta Neurochir (Wien) 1993; 121 (3-4) 95-99
  • 12 Sawauchi S, Murakami S, Ogawa T, Abe T. [Acute subdural hematoma associated with diffuse brain injury: analysis of 526 cases in Japan neurotrauma data bank]. No Shinkei Geka 2007; 35 (01) 43-51
  • 13 Kameyama M, Karibe H, Onuma T, Tominaga T. Epidemiological study of head injury in Miyagi neurotrauma databank: age, cause of injury, pathophysiology and outcome. Neurotraumatology 2008; 31: 49-56
  • 14 Massaro F, Lanotte M, Faccani G, Triolo C. One hundred and twenty-seven cases of acute subdural haematoma operated on. Correlation between CT scan findings and outcome. Acta Neurochir (Wien) 1996; 138 (02) 185-191
  • 15 van den Brink WA, Zwienenberg M, Zandee SM, van der Meer L, Maas AI, Avezaat CJ. The prognostic importance of the volume of traumatic epidural and subdural haematomas revisited. Acta Neurochir (Wien) 1999; 141 (05) 509-514
  • 16 Mulligan P, Raore B, Liu S, Olson JJ. Neurological and functional outcomes of subdural hematoma evacuation in patients over 70 years of age. J Neurosci Rural Pract 2013; 4 (03) 250-256
  • 17 Umezawa K, Kimura S, Ogita S, Takegami T, Ikeda E. Analysis of 469 cases of acute subdural hematoma: the characteristics of “talk and deteriorate” patients. Neurotraumatology 2011; 34: 132-138
  • 18 Koç RK, Akdemir H, Oktem IS, Meral M, Menkü A. Acute subdural hematoma: outcome and outcome prediction. Neurosurg Rev 1997; 20 (04) 239-244
  • 19 Wilberger Jr JE, Harris M, Diamond DL. Acute subdural hematoma: morbidity, mortality, and operative timing. J Neurosurg 1991; 74 (02) 212-218
  • 20 Maas AI, Murray GD, Roozenbeek B. et al International Mission on Prognosis Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) Study Group. Advancing care for traumatic brain injury: findings from the IMPACT studies and perspectives on future research. Lancet Neurol 2013; 12 (12) 1200-1210
  • 21 Farace E, Alves WM. Do women fare worse: a metaanalysis of gender differences in traumatic brain injury outcome. J Neurosurg 2000; 93 (04) 539-545
  • 22 Jeffree RL, Gordon DH, Sivasubramaniam R, Chapman A. Warfarin related intracranial haemorrhage: a case-controlled study of anticoagulation monitoring prior to spontaneous subdural or intracerebral haemorrhage. J Clin Neurosci 2009; 16 (07) 882-885
  • 23 Basmaci M, Hasturk AE. Chronic subdural hematoma in a child with acute myeloid leukemia after leukocytosis. Indian J Crit Care Med 2012; 16 (04) 222-224
  • 24 Fryburg K, Nguyen HS, Cohen-Gadol AA. Spontaneous acute subdural hematoma due to fondaparinux: Report of two cases. Surg Neurol Int 2011; 2: 44
  • 25 Stocchetti N, Pagan F, Calappi E. et al Inaccurate early assessment of neurological severity in head injury. J Neurotrauma 2004; 21 (09) 1131-1140
  • 26 Marmarou A, Lu J, Butcher I. et al Prognostic value of the Glasgow Coma Scale and pupil reactivity in traumatic brain injury assessed pre-hospital and on enrollment: an IMPACT analysis. J Neurotrauma 2007; 24 (02) 270-280
  • 27 Chen SH, Chen Y, Fang WK, Huang DW, Huang KC, Tseng SH. Comparison of craniotomy and decompressive craniectomy in severely head-injured patients with acute subdural hematoma. J Trauma 2011; 71 (06) 1632-1636
  • 28 Marmarou A, Lu J, Butcher I. et al IMPACT database of traumatic brain injury: design and description. J Neurotrauma 2007; 24 (02) 239-250
  • 29 Shima K, Aruga T, Onuma T, Shigemori M. Members of the Japanese Guidelines Committee on the Management of Severe Head Injury (2nd Edition), Japan Society of Neurotraumatology. JSNT-Guidelines for the Management of Severe Head Injury (abridged edition). Asian J Neurosurg 2010; 5: 15-23
  • 30 Tien HC, Jung V, Pinto R, Mainprize T, Scales DC, Rizoli SB. Reducing time-to-treatment decreases mortality of trauma patients with acute subdural hematoma. Ann Surg 2011; 253 (06) 1178-1183
  • 31 Servadei F, Nasi MT, Giuliani G. et al CT prognostic factors in acute subdural haematomas: the value of the ‘worst’ CT scan. Br J Neurosurg 2000; 14 (02) 110-116
  • 32 Howard III MA, Gross AS, Dacey Jr RG, Winn HR. Acute subdural hematomas: an age-dependent clinical entity. J Neurosurg 1989; 71 (06) 858-863
  • 33 Oh CH, Park CO, Hyun DK, Park HC, Yoon SH. Comparative study of outcomes between shunting after cranioplasty and in cranioplasty after shunting in large concave flaccid cranial defect with hydrocephalus. J Korean Neurosurg Soc 2008; 44 (04) 211-216
  • 34 Schaller B, Graf R, Sanada Y, Rosner G, Wienhard K, Heiss WD. Hemodynamic and metabolic effects of decompressive hemicraniectomy in normal brain. An experimental PET-study in cats. Brain Res 2003; 982 (01) 31-37