Open Access, Peer-reviewed
pISSN 2234-8999  eISSN 2288-2243
    J Korean Neurotraumatol Soc. 2009 Jun;5(1):1-4. Korean.
    Published online Jun 30, 2009.
    https://doi.org/10.13004/jknts.2009.5.1.1
    Copyright © 2009 Journal of Korean Neurotraumatology Society
    Original Article

    Outcome of the Severe Acute Subdural Hematoma

    Jae-Sang Oh, MD, Kyeong-Seok Lee, MD, Ra-Sun Kim, MD and Jae-Won Doh, MD
      • Department of Neurosurgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, Korea.
    • Address for correspondence: Kyeong-Seok Lee, MD. Department of Neurosurgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Soonchunhyang 2-gil 8, Dongnam-gu, Cheonan 330-721, Korea. Tel: +82-41-570-3652, Fax: +82-41-572-9297, Email: ksleens@sch.ac.kr
    Received January 14, 2009; Revised May 11, 2009; Accepted May 11, 2009.

    Abstract

    Objective

    Acute subdural hematoma (ASDH) is one of the worst post-traumatic mass lesions. Early aggressive management may reduce the mortality rate, while it may cause unbearable sequelae or disabilities. Traditionally a surgical decision is made by the surgeon on the critical victim without delay. However, it is necessary to inform the relatives or family not only the possibility of survival, but also the quality of life after surgery, especially for the comatose victims with ASDHs. We investigate the outcome of the comatose (Glascow coma scale 3-8) patients with ASDH.

    Methods

    From January 2005 to December 2006, we managed 141 patients with ASDH. In 52 patients, their initial Glasgow coma score (GCS) was 3-8. We examined the age, initial GCS, size and reflex of pupils, method of treatment, and the outcome at discharge. We also investigated the amount the hematoma, degree of midline shift, and status of the basal cisterns in computed tomographic scans. Statistical significance was tested using the chi-square test. It was considered significant, when p<0.05.

    Results

    The overall outcome was poor; death in 29, vegetative in 12, severe disability in 10, and moderate disability in 1. There was no good recovery, at all. The outcome was dependent on the initial GCS and pupil. The outcome was independent on the age, amount of the hematoma, degree of midline shift, and method of treatment. However, the age was the only significant factor in deciding not to operate.

    Conclusion

    In severe head injuries, even though we could save the life, the quality of life is too poor to bother not only the victims, but also their family and society. In this situation, it is never sufficient to explain that an immediate surgery is the only way to save the life. We should provide the information on the outcome of the severe head injuries after surgery.

    Keywords
    Acute subdural hematoma; Craniocerebral trauma; Decision making; Treatment outcome

    Tables

    TABLE 1
    Comparison by the methods of treatment

    TABLE 2
    Comparison by the outcome

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    MeSH Terms
    Coma
    Craniocerebral Trauma
    Decision Making
    Hematoma
    Hematoma, Subdural, Acute
    Humans
    Pupil
    Quality of Life
    Reflex
    Treatment Outcome
    Metrics
    Share
    Tables
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