ABSTRACT
Background: Acute subdural hematoma (ASDH) is seen in approximately one-third of patients with severe traumatic brain injury and in half to more than two-thirds of those undergoing hematoma evacuation. ASDH is associated with high rates of mortality, ranging from 40% to 90%. The aim of this study is to analyze the clinical spectrum and to evaluate the outcome. Methods: It is a prospective study conducted at the Department of Neurosurgery, Rangaraya Medical College, Kakinada, over a period of 2 years from December 2015 to December 2017. 100 cases are taken for study with head injury, diagnosed to have traumatic ASDH. A detailed clinical history, clinical examination, and computed tomography (CT) scan performed in all cases. Patients segregated as mild, moderate, and severe types of head injuries and studied various factors such as age, sex, mode of injury, Glasgow coma score at admission, pupillary reactivity, surgical/conservative management, and Glasgow outcome score. Results: About 49% of patients are in 3rd–5th decade, percentage of mortality is increasing with age. Male predominance is seen. Rural population is more affected than urban. Road traffic accidents are the most common mode of head injuries. Glasgow coma scale (GCS) between 9 and 12 was found in 46% of patients. Moderate type of TBI is the most common type of neurological presentation at the time of admission. CT images of 53 patients showed <5 mm thickness, 23 patients showed 5–10 mm, in 24 patients, it is >10 mm. Of 100 patients, surgical approach is considered in 50 patients while the remaining 50 patients were managed conservatively. Conclusions: GCS between 9 and 12 was found most common mode of presentation at the time of admission GCS <8 showed highest mortality of 80%, GCS 13–15 showed no mortality. Prognosis is worse in patients with pupillary abnormalities than those without. Early surgery leads to better prognosis.
ABSTRACT
Background: Epidemiological knowledge of Acute Subdural Haematoma (ASDH) is needed to prevent and to develop care and rehabilitation of patients. Aims & Objectives: The aims and objectives of this study is to find the solotionsto decrease the incidence of ASDH and offer recommondationsto their prevention. Material & Methods: It is a prospective study conducted in Department of Neurosurgery, Rangaraya Medical College, Kakinada over a period of two years from December 2015 to December 2017. 100 cases are taken for study with head injury, diagnosed to have traumatic Acute Subdural Haematoma (ASDH). Epidemiological pattern of ASDHis studied by performing a systematic review of literature, using information obtained from our centerGovernment General Hospital, Neurosurgery Department, Kakinada. collecting data on demographics, showing characteristics of ASDH including incidence, identification of risk groups on differences in age, gender, geographical variation, severity and mortality. Results: Studies suggest that the incidence of ASDH is between 10 -45 % leading cause of death. Men and people living in social and economical deprived areas, usually young adults and the elderly are high-risk groups for ASDH.: 49% of patients are in 3rd to 5th decade., percentage of mortality is increasing with age. Male predominance is seen. Rural population is more effected than urban. Road Traffic Accidents are the most common mode of head injuries GCS between 9-12 was found in 46% of patients and is most common mode of presentation at the time of admission Conclusions: Most public epidemiological data showed that ASDH is a major cause of mortality and disability. The effort to understand ASDH and the available strategies to treat this lesion, in order to improve clinical outcomes after ASDH, may be based on an increase in research on the epidemiology of ASDH.
ABSTRACT
Background: Acute SDH is seen in approximately one third of patients with severe TBI and in half to more than two thirds of those undergoing hematoma evacuation. Acute SDH is associated with high rates of mortality. Surgical treatment is still Controversial. an analysis of our institutional data is performed in patients with traumatic ASDH to study factors determining clinical outcome. Methods: 50 patients with ASDH underwent surgical treatment are taken for prospective study in our Neurosurgery department, Rangaraya Medical College, Kakinada, between Dec.,2015 to Dec.,2017. Information including patient characteristics, treatment modality, radiologic features, and functional outcome were analyzed. Outcome was assessed according to the Glasgow Outcome Scale (GOS) at 1 month. Furthermore, a multivariate analysis was performed to identify independent predictors of functional outcome. Results: 22% of patients with ASDH after Decompressive Craniectomy achieved favorable outcome. <60 years male patients are commonly effected. Road Traffic Accidents are common mode of injury. Right side Decompressive Craniectomies are commonly done. In this study the overall mortality rate is 60%. Conclusions: A detailed data is provided on patients with ASDH. Despite poor GCS at admission & dilated pupils favorable outcome may be achieved in many patients after Decompressive Craniectomy. Nevertheless, careful individual decision making is necessary for each patient, especially when signs of cerebral herniation have persisted for a long time.
ABSTRACT
Background: Low Glasgow coma scale score (GCS) and pupillary status predict poor outcomes in traumatic acute subdural hematoma (ASDH) patients. We compared the mortality of GCS 3 patients having bilateral fixed and dilated pupils (BFDPs) with GCS 3 patients having reactive pupils (RPs). We then determined if trauma system or patient factors were responsible for the difference in mortality. Methods: We reviewed all adult, traumatic ASDH patients with GCS 3, admitted to our institution from December 1, 2015 to December 31, 2017. Demographics, injury data, prehospital times, procedures, and outcomes were recorded. Results: During this period, 145 patients were admitted with GCS of 3, and met inclusion criteria. In all, 100 patients were analyzed, after excluding 20 patients who were dead on arrival, and 25 others, who were intoxicated with alcohol or received paralytic agents in the trauma room. All BFDP patients died, whereas 87% of RP patients died. With regard to patient factors, BFDP patients were more likely to be unstable, have extra-axial bleeding, and evidence of midline shift and/or herniation. Trauma system factors, however, may also have had an impact on outcome. Despite having more extra-axial bleeding, BFDP patients were less likely to have a neurosurgical operation than RP patients. Conclusion: Patients with GCS of 3 and BFDPs have a 100% mortality. These patients have suffered devastating brain injuries and tend to be hemodynamically unstable. Clinicians, however, are less likely to aggressively treat BFDP patients than RP patients. Further prospective studies are required to determine which patients with GCS of 3, and BFDPs are likely to benefit from aggressive treatment.