Īccording to the current guidelines, an ASDH with a thickness greater than 10 mm or a midline shift greater than 5 mm on computed tomographic (CT) scan should be surgically evacuated, regardless of the patient’s Glasgow Coma Scale (GCS) score. It is commonly associated with brain edema, subarachnoid hemorrhage, brain contusions, and diffuse axonal injury, and all affect the neurological outcome. Generally, traumatic acute subdural hematoma (ASDH) results in high mortality despite intensive treatment. Randomized controlled trials are needed to set a standard of care for the management of ASDH in this subgroup of the severe head injury patients. This study emphasized that both surgical and conservative management of ASDH had similar dismal results and that there was no additional benefit from surgical intervention in the studied group of head injury patients. All patients (100%) died in the intensive care unit within 1 month after trauma. Sixty-two patients (30%), including 38 anonymous patients, were surgically managed and the remainder were managed conservatively. The mean duration between trauma and admission was 41 min. One hundred forty-two patients (68.9%) were males. Two hundred six patients met the inclusion criteria of this study. The inclusion criteria were the patients with an extension or no motor response to pain after resuscitation with an ASDH > 10 mm in thickness and a midline shift > 5 mm in the initial head computed tomography (CT) scan. This retrospective study reviewed the severe head injury patients admitted to our university hospitals from January 2014 to August 2017. The aim of the present study was to assess the prognosis of ASDH of > 10 mm in thickness in head injury patients with an extension or no motor response to pain after resuscitation. Further prospective studies are required to determine which patients with GCS of 3, and BFDPs are likely to benefit from aggressive treatment.Most of the studies that examined the prognosis of acute subdural hematoma (ASDH) in severe head injury patients stated their overall prognosis as one group. Clinicians, however, are less likely to aggressively treat BFDP patients than RP patients. These patients have suffered devastating brain injuries and tend to be hemodynamically unstable. Conclusion: Patients with GCS of 3 and BFDPs have a 100% mortality. Despite having more extra-axial bleeding, BFDP patients were less likely to have a neurosurgical operation than RP patients. Trauma system factors, however, may also have had an impact on outcome. With regard to patient factors, BFDP patients were more likely to be unstable, have extra-axial bleeding, and evidence of midline shift and/or herniation. All BFDP patients died, whereas 87% of RP patients died. In all, 100 patients were analyzed, after excluding 20 patients who were dead on arrival, and 25 others, who were intoxicated with alcohol or received paralytic agents in the trauma room. Results: During this period, 145 patients were admitted with GCS of 3, and met inclusion criteria. Demographics, injury data, prehospital times, procedures, and outcomes were recorded. Methods: We reviewed all adult, traumatic ASDH patients with GCS 3, admitted to our institution from Decemto December 31, 2017. We then determined if trauma system or patient factors were responsible for the difference in mortality. We compared the mortality of GCS 3 patients having bilateral fixed and dilated pupils (BFDPs) with GCS 3 patients having reactive pupils (RPs). ABSTRACT Background: Low Glasgow coma scale score (GCS) and pupillary status predict poor outcomes in traumatic acute subdural hematoma (ASDH) patients.
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