Assessing the Neurological Outcome of Traumatic Acute Subdural Hematoma Patients with and without Primary Decompressive
We have investigated the impact of primary decompressive craniectomies on neurological outcomes after adjusting for other predictive variables.
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Abstract Background We have investigated the impact of primary decompressive craniectomies on neurological outcomes after adjusting for other predictive variables. Method 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. Conclusion Primary decompressive craniectomy failed to show benefit in terms of neurological outcomes and should be reserved for cases with uncontrolled intra-operative brain swelling. Keywords Acute subdural hematoma • craniotomy • decompressive craniectomy • neurological outcome
G.K.-C. Wong (), Y.-W. Hung, C. Chong, S. Chi-Ping Ng, and W.-S. Poon Division of Neurosurgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR e-mail: [email protected] T. Rainer, and J. Yeung Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
Introduction Despite studies of the impact of early craniectomy on patients with traumatic acute subdural hematoma (5,7,8) the value of primary decompressive craniectomies remains uncertain. There is only one literature reference that compares mortality rates between normal craniotomies and decompressive craniectomies (10). Woertgen et al. found that there was no difference between the two groups. However, their analysis was not adjusted for age, the Glasgow coma scale or signs of herniation. We sought to judge the value of decompressive craniectomy with reference to functional outcome after taking into account other patient disabilities. We designed the current study to investigate the impact of primary decompressive craniectomy on neurological outcomes as well as other prognostic factors.
Methods and Materials We collected data from trauma patients with traumatic acute subdural hematomas in a regional trauma center in Hong Kong over a 4-year period. Out of 464 patients who had significant head injuries, 100 patients had acute subdural hematomas and were recruited for analysis. Of the 34 patients who underwent surgical evacuation of their hematomas, 15 were subjected to normal craniotomies, while 19 had decompressive craniectomies (one patient who had a craniotomy also had a secondary craniectomy afterwards). Data regarding the age, sex, Glasglow coma scale (9) (GCS), GCS motor component, signs of herniation (unilateral or bilateral pupil dilation), extradural hematoma, cereb
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