The common teaching is that patients with traumatic subdural hematoma don’t do well. This is generally due to the presence of more direct injury to the brain compared with patients who have epidural hematoma. Outcomes data tends to bear this out. However, this data is at least 20 years old and it would be nice to know if we’ve made any progress in the management of this injury.
Harborview Medical Center retrospectively reviewed four years worth of its trauma registry data on patients with subdural hematoma. They scrutinized the usual outcomes data, looking at patients with and without surgical decompression. During the study period, clinical management routines remained basically the same.
A total of 1427 patients were included in the study. The average age was 58. Interesting facts from the study include:
- Falls were by far the most common mechanism (57%)
- Most patients (58%) had a GCS of 13 or higher
- The TRISS probability of survival was slightly lower in the evacuated group (85%) versus the non-evacuated group (91%), yet
- Mortality rate was 14%, with traumatic brain injury the most common cause of death
- 29% had positive urine toxicology testing. Marijuana was most prevalent.
- Slightly more than half were discharged home. Independence was higher in the group who had undergone evacuation of their hematoma.
Bottom line: Patients with subdural hematoma do better these days than they used to. This is probably due to better imaging (CT), which leads to earlier and more accurate management. Additionally, these injuries are now treated at regional trauma centers like Harborview, which may also improve survival.
Reference: Acute traumatic subdural hematoma: Current mortality and functional outcomes in adult patients at a Level I trauma center. J Trauma 73(5):1348-1354, 2012.