A Clinical Study of Acute Subdural Hematoma: A Prospective Study

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.