Assessing the neurological outcome of traumatic acute subdural hematoma patients with and without primary decompressive craniectomies.
BACKGROUND
We have investigated the impact of primary decompressive craniectomies on neurological outcomes after adjusting for other predictive variables.


METHODS
We have collected data from trauma patients with acute subdural hematomas in a regional trauma center in Hong Kong over a 4-year period. Patient risk factors were investigated using logistic regression.


RESULTS
Out of 464 patients with significant head injuries, 100 patients had acute subdural hematomas and were recruited for analysis. Forty-four percent of the patients achieved favorable neurological outcomes after 6 months. Favorable neurological outcomes at 1 year were related to age, pupil dilatation, and motor GCS scores at the time of admission. In the 34 patients who underwent evacuation of acute subdural hematomas, primary decompressive craniectomy was not associated with favorable neurological outcomes.


CONCLUSIONS
Primary decompressive craniectomy failed to show benefit in terms of neurological outcomes and should be reserved for cases with uncontrolled intra-operative brain swelling.
Wong
George Kwok-Chu
GK
Division of Neurosurgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR. georgewong@surgery.cuhk.edu.hk
Hung
Yuk-Wah
YW
Chong
Charing
C
Yeung
Janice
J
Chi-Ping Ng
Stephanie
S
Rainer
Tim
T
Poon
Wai-Sang
WS
D000368:Aged; D000369:Aged, 80 and over; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D006408:Hematoma, Subdural / Q000503:physiopathology* / Q000601:surgery*; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index