Acute subdural hematoma: severity of injury, surgical intervention, and mortality.
Sixty patients with acute subdural hematoma were treated at Tokyo Metropolitan Hiroo Hospital between 1981 and 1989. The overall mortality was 55% and the functional recovery rate 30%. Thirteen (93%) of 14 patients with a Glasgow Coma Scale (GCS) score of 3 died, while all eight patients with a GCS score of 7 or more achieved functional recovery. The mortality of patients with GCS scores of 4-6 ranged from 45 to 67%. Patients with GCS scores of 4-6 over 65 years old had a mortality of 82%, compared to 50% mortality for those aged 19-40 years. The mortality for patients with GCS scores of 4-6 operated on within 4 hours of injury was 62% in contrast to 33% for those operated on from 4 to 10 hours. Patients with GCS scores of 4-6 who underwent craniotomy with evacuation of the hematoma achieved significantly better recovery than those treated by burr holes. Four patients with GCS scores of 4-6 died in spite of decompressive craniectomy or craniotomy with duroplasty. The mortality is only influenced by age and type of surgical intervention among patients with GCS scores of 4-6. Shorter time from injury to surgical evacuation does not affect mortality within 10 hours of injury.
Hatashita
S
S
Department of Neurosurgery, Juntendo University Urayasu Hospital, Urayasu, Chiba.
Koga
N
N
Hosaka
Y
Y
Takagi
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy; D005260:Female; D015600:Glasgow Coma Scale; D006408:Hematoma, Subdural / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis