Introduction: Acute subdural hematomas (ASDH) can be fatal sequela to traumatic brain injury (TBI). Timely surgical decompression has always been the goal of therapy. Time to surgery has been quantified with regards to mortality but never to the Glasgow Outcome Score (GOS). The aim of this multicenter study was to establish whether reduction in the time interval between injury and surgical decompression could improve the GOS in patients at 3 months.
Methods: Consecutive patients with TBI admitted to the neurosurgical departments of three tertiary level hospitals were evaluated for the study. Only adult patients with supratentorial ASDH measuring at least 10 mm clot thickness and 5 mm midline shift, thus requiring surgery, were included in the study. The time of injury needed to have been clearly documented to allow inclusion. Exclusion criteria included children, those not salvageable and those that did not meet the criteria for surgical decompression. Statistical analysis was performed using SPSS software.
Results: 4255 patients with TBI were admitted to the three hospitals over a ten year period. During this timeframe, 855 comatose patients with ASDH with or without intracerebral hemorrhage were enrolled. Assault was the commonest etiology. Mean time to surgery was 5 hours and 25 minutes. Although there was no statistically significant difference between GOS and gender or demographics, there was however a statistically significant correlation with GOS and motor score (P <0.001), intracranial pressure (P < 0.001) and time to surgical decompression (P < 0.0001). Using multivariate analysis, the data suggests that surgery under 3.25 hours is associated with the best outcome at 3 months (P < 0.001).
Conclusions: Our study suggests that younger age, lower ICP and higher motor scores are associated with improved outcome after ASDH. Shortened time to surgical decompression however is also associated with improved GOS at 3 months irrespective of motor score.
Patient Care: Timely surgical decompression may lead to improved outcomes in patients with acute subdural hematomas.
Learning Objectives: By the conclusion of this session, participants would understand that need for timely surgical decompression. Although one would think this was obvious, the actual optimal time (3.5 hours) has not previously been quantified. Never has a study with this many participants been documented.