Traumatic Acute Subdural Hematoma

TLDR

The study reviewed records of 82 comatose traumatic ASDH patients treated under a uniform protocol to identify factors influencing recovery after surgical decompression. Early surgery within four hours dramatically lowered mortality (30% versus 90%) and other prognostic factors included initial neuro exam, sex, multimodality‑evoked potentials, and postoperative ICP, indicating that rapid access to equipped centers could substantially reduce deaths. N Engl J Med 1981; 304:1511–8.

Abstract

To discover which factors contributed to recovery after surgical intracranial decompression, we reviewed the records of 82 consecutive comatose patients with traumatic acute subdural hematoma (ASDH) who were treated in a single center under a uniform protocol. The delay from injury to operation was the factor of greatest therapeutic importance. Patients who underwent surgery within the first four hours had a 30 per cent mortality rate, as compared with 90 per cent in those who had surgery after four hours (P<0.0001). Other important prognostic variables included results of the initial neurologic examination, sex, multimodality-evoked potentials, and postoperative intracranial pressure (ICP). If all patients with traumatic ASDH were taken directly to hospitals equipped to diagnose and remove the hematoma within four hours of injury, mortality rates could be reduced considerably. (N Engl J Med. 1981; 304:1511–8.)