title: Survival Trends After Surgery for Acute Subdural Hematoma in Adults Over a 20-year Period.
abstract: We sought to determine 30-day survival trends and prognostic factors following surgery for acute subdural hematomas (ASDHs) in England and Wales over a 20-year period.
  
  
  
  ASDHs are still considered the most lethal type of traumatic brain injury. It remains unclear whether the adjusted odds of survival have improved significantly over time.
  
  
  
  Using the Trauma Audit and Research Network (TARN) database, we analyzed ASDH cases in the adult population (>16 yrs) treated surgically between 1994 and 2013. Two thousand four hundred ninety-eight eligible cases were identified. Univariable and multiple logistic regression analyses were performed, using multiple imputation for missing data.
  
  
  
  The cohort was 74% male with a median age of 48.9 years. Over half of patients were comatose at presentation (53%). Mechanism of injury was due to a fall (<2 m 34%, >2 m 24%), road traffic collision (25%), and other (17%). Thirty-six per cent of patients presented with polytrauma. Gross survival increased from 59% in 1994 to 1998 to 73% in 2009 to 2013. Under multivariable analysis, variables independently associated with survival were year of injury, Glasgow Coma Scale, Injury Severity Score, age, and pupil reactivity. The time interval from injury to craniotomy and direct admission to a neurosurgical unit were not found to be significant prognostic factors.
  
  
  
  A significant improvement in survival over the last 20 years was observed after controlling for multiple prognostic factors. Prospective trials and cohort studies are expected to elucidate the distribution of functional outcome in survivors.
authors.affiliation: *Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK †The Trauma Audit and Research Network, University of Manchester, Salford, UK ‡Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK §MRC Biostatistics Unit, Institute of Public Health, University of Cambridge, Cambridge, UK ||Emergency Medicine Research in Sheffield (EMRiS), Health Services Research, School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Fountain
authors.forename: Angelos G
authors.initials: AG
authors.lastname: Kolias
authors.forename: Fiona E
authors.initials: FE
authors.lastname: Lecky
authors.forename: Omar
authors.initials: O
authors.lastname: Bouamra
authors.forename: Thomas
authors.initials: T
authors.lastname: Lawrence
authors.forename: Hadie
authors.initials: H
authors.lastname: Adams
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Bond
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hutchinson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D003399:Craniotomy / Q000379:methods; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D020199:Hematoma, Subdural, Acute / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057216:Propensity Score; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends*; D061665:Time-to-Treatment; D016896:Treatment Outcome; D006113:United Kingdom