Predictors of Outcome in Acute Subdural Hematoma: A Retrospective Single-Center Analysis of 319 PatientsUllrich Meier, MD, PhD1, Ferass AlZain, MD1, Martina Ebenau1, Johannes Lemcke, MD11Berlin, Germany Keywords: craniotomy, risk factor, outcome, trauma, subdural hematoma
The aim of our study is the systematic identification of predictors of the outcome in a very large group of patients with an acute subdural hematoma.
105 women (33%) and 214 men (67%) between 1 and 100 years (mean 59 years) were included in the study.
In a retrospective study the records of all patients admitted between 2001 and 2007 to a large emergency hospital with an acute SDH due to TBI were analysed. Initial GCS, clinical state and GOS were documented for all patients. All CT and MRI scans of the patients were saved in an electronic storage system and have been reviewed by neurosurgeon and a neuroradiologist.
At admission 121 (38%) patients had a GCS of 3-5, 48 (15%) GCS 6-9, 63 (20%) GCS 10-13 and 87 (27%) GCS 14 or 15. 129 (41%) patients died (GOS 1), 22 (7%) remained in a persistent vegetative state (GOS 2), 68 (21%) had a severe handicap (GOS 3), 48 (15%) respectively 52 (16%) had a slight or no handicap (GOS 4 or 5). The initial GCS had a significantly predictive value: 62% of the patients admitted with GCS 3-5 died whereas only 13% of the patients admitted with GCS 14 or 15 died. 86% of the patients with bilateral dilatated pupils died. The size of the hematoma and the degree of the midline shift had a significant influence to the outcome (p < 0.01). 79% of the patients with a midline shift of <20mm and an initial GCS of 3-5 died.
This is a retrospective study.
Large size of the SDH, extensive midline shift, bilateral mydriasis and a low initial GCS are associated with a substantially higher probability of hospital mortality.
Although, the limitations of a retrospective analysis are well-known, the benefit of surgery for patients with a combination of predictors of a negative outcome is very doubtful. Project Roles:
U. Meier (), F. AlZain (), M. Ebenau (), J. Lemcke ()