Background: Acute subdural hematoma (aSDH) is a major cause of admission at Neurosurgical Emergency
Department. Nevertheless, concerns regarding surgical indication in patients with
multiple comorbidities, poor neurological status, antithrombotic therapy, and older
age still persist. Therefore, a correct recognition of predictive outcome factors
at hospital discharge is crucial to an appropriate neurosurgical treatment. Methods: Eighty-nine medical records of consecutive patients with age ≥18 years old who were
submitted to aSDH evacuation between January 2008 and May 2012 were reviewed. Demographic
characteristics, neurological status on admission, anticoagulant or antiplatelet therapy,
and outcome on discharge were collected. Patients with insufficient data concerning
these variables were excluded from the study. Results: Sixty-nine patients were included; 52% were male; 74% were older than 65 years; 41%
were under oral antithrombotic therapy (OAT); at admission, 54% presented with Glasgow
coma scale (GCS) ≤8; 23% were submitted to a craniectomy instead of a craniotomy;
26% of the patients died, 32% were dependent, and 42% were independent on discharge.
Crude analysis revealed craniectomy, A/A pupils, GCS ≤8 at admission statistically
significant related with the worst outcome (P < 0.05). In the adjusted evaluation
only A/A pupils (P = 0.04) was associated to poor outcome (spontaneous etiology P
= 0.052). Considering daily living independency at hospital discharge, either male
gender (P = 0.044) and A/A pupils (P = 0.030) were related to the worst outcome. No
effect of age in outcome was observed. Conclusions: Male gender and A/A pupils are associated with lower probability of achieving independency
living at hospital discharge. A/A pupils, low GCS at admission, spontaneous etiology,
and craniectomy were associated with the worst outcome. Age and OAT were not predictive
factors in this series. Caution should be taken when considering these factors in
the surgical decision.
Key-words:
Acute subdural hematoma - age - anticoagulant/antiplatelet therapy - craniectomy -
craniotomy - Glasgow outcome score
