Journal List > Korean J Neurotrauma > v.9(1) > 1058911

Korean J Neurotrauma. 2013 Apr;9(1):12-16. Korean.
Published online April 30, 2013.  https://doi.org/10.13004/kjnt.2013.9.1.12
Copyright © 2013 Korean Neurotraumatology Society
Clinical Outcomes of Patients with Good Neurological Scores in Spite of Significant Amounts of Acute Subdural Hematoma
Ho-Jun Kang, MD, Yoon-Soo Lee, MD, Sang-Jun Suh, MD, Jeong-Ho Lee, MD, Kee-Young Ryu, MD and Dong-Gee Kang, MD
Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea.

Address for correspondence: Yoon-Soo Lee, MD. Department of Neurosurgery, Daegu Fatima Hospital, 576-31 Sinam-dong, Dong-gu, Daegu 701-600, Korea. Tel: +82-53-940-7339, Fax: +82-53-954-7417, Email: paulyoonsoolee@hanmail.net
Received February 08, 2013; Revised March 11, 2013; Accepted March 12, 2013.

Abstract

Objective

Acute subdural hematoma (ASDH) with good initial Glasgow Coma Scale (GCS) score 13-15 is generally regarded as a mild head injury. However, the risk increases when significant amount of hematoma with midline shift exists. This study is to evaluate the clinical outcomes of patients with good neurological scores in spite of significant amounts of ASDH, and to compare the outcomes according to the treatment modalities.

Methods

Sixty patients with initial GCS score 13-15 in spite of significant amounts of ASDH and midline shifts were enrolled. They were divided into groups according to age, sex, side of location, initial GCS score, midline shift, and hematoma thickness. According to the therapeutic modalities, early craniotomy and initially conserved groups were identified, and initially conserved group was further classified into persistently conserved and delayed operation groups. The outcomes were measured by Glasgow Outcome Scale.

Results

Initial GCS score was a significant factor that influenced the final outcome (p=0.001). The outcomes were good in both early craniotomy and initially conserved groups without significant differences (p=0.268). Fifteen of initially conserved 49 patients underwent delayed operations from neurological deteriorations, but the outcomes were good without significant differences from persistently conserved group (p=0.481).

Conclusion

Initial GCS score is an important factor that influences the clinical outcome. These patients can be conserved under close observations without early preventive craniotomies if no deteriorations are seen in the acute stage. Only those with delayed deteriorations may require simple operations such as burr hole trephinations which still guarantee good outcomes.

Keywords: Acute subdural hematoma; Glasgow Coma Scale; Glasgow Outcome Scale

Tables


TABLE 1
Clinical and radiological factors in relation to GOS (n=60)
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TABLE 2
Initial therapeutic modalities in relation to GOS
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TABLE 3
Initially conserved group in relation to GOS
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Notes

The authors have no financial conflicts of interest.

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