title: Criteria for conservative treatment of supratentorial acute subdural haematomas.
abstract: Without mortality, 31 patients underwent conservative treatment for traumatic supratentorial acute subdural haematoma (SDH). Later on six of them had the haematoma surgically evacuated mainly because of a deterioration of the Glasgow Coma Scale (GCS) scores. It was found that patients with a midline shift of less than 10 mm on the computed tomography (CT) scans and with a GCS score of 15 initially might be treated conservatively under close observation, reserving urgent craniotomy and evacuation of the SDH for those with deteriorating neurological conditions. A smaller degree of midline shift was tolerated by patients with an GCS score of less than 15: a shift of more than 5 mm on the initial CT scans predicted an exhaustion of the cerebral compensatory mechanism within 3 days of injury. In such cases the GCS score worsened, and surgical evacuation of the SDH became necessary. A total hospital stay of 6 to 7 days may suffice for those who have become fully conscious. Repeat CT studies before discharge should be done and a close follow-up during the first 3 to 4 weeks is advisable.
authors: Department of Surgery, Chang Gung Memorial Hospital and Medical College, Taipei, Taiwan, Republic of China.
authors: C W
authors: CW
authors: Wong
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D003399:Craniotomy; D005260:Female; D005500:Follow-Up Studies; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012887:Skull Fractures / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome