Research Journal of Medical Sciences
ISSN: Online 1993-6095ISSN: Print 1815-9346
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Abstract
Head injury, often resulting from accidents or falls, is a severe form of trauma. Unconscious patients frequently exhibit acute subdural hematoma as a consequence, which is associated with a high mortality rate ranging from 55‐80%, even in specialised medical facilities. The causes of mortality can be attributed to various factors, including co‐existing medical conditions and the severity of associated brain injury. Multiple studies have examined the impact of factors such as age, level of consciousness, brain stem reflexes, computed tomography (CT) findings and the timing of surgical intervention on the prognosis of acute subdural hematoma. These factors play a critical role in determining the outcome of this condition. The purpose of this study was to assess the various factors which affect the outcome in acute traumatic subdural hematoma in local population. This retrospective study included all operated 108 patients admitted with traumatic acute subdural hematoma under department of neurosurgery , GRMC and associated J.A. group of Hospitals from January 2021 to December 2022 who seek medical or surgical management. No randomisation done. A total of 224 patients were admitted to the head injury unit with acute subdural hematoma. Out of these, 108 cases underwent surgical intervention. The highest proportion of operated patients 75.9% with acute subdural hematoma fell within the 21‐50 age group. In terms of pupillary examination, 46.2% of patients exhibited normal pupillary size with sluggish light reflex and preserved doll's eye movement. The majority of patients 79.6% had computed tomography findings indicating midline shift and effaced basal cisterns. No patients presented for surgery within3 hrs of injury. Most patients 83.3% underwent surgery between 6‐12 hrs after injury. The age group of 21‐40 years showed a higher rate of good survival, while the outcome was poorer in the age group above 60 years. The overall survival rate for patients was 27%. Patients with GCS scores of 13‐15 had better outcomes, whereas those with GCS scores of 3‐8 had poorer outcomes. The presence of preserved pupillary light reflex and doll's eye movement correlated with a favourable outcome, while impaired or absent doll's eye movement with impaired or absent light response correlated with a poor outcome. The time interval between injury and surgery was found to significantly impact the outcome in this study. Traumatic acute subdural hematoma remains associated with a high mortality rate despite advancements in neurosurgery. Initially low Glasgow Coma Scale scores and hypoxia are important predictors of mortality. Different surgical procedures, such as craniotomy and decompressive craniotomy, have shown effectiveness without clear superiority. The GCS scores, pupillary reaction and CT findings are potential indicators of salvageability and outcome.
How to cite this article:
Kankane Vivek Kumar, Jeswani Mayank, Shukla Avdhesh, Sutradhar Sridham and Sharma Avinash. Evaluation of Prognostic Factors in Acute Subdural Hematoma Due to Traumatic Brain Injury.
DOI: https://doi.org/10.36478/10.59218/makrjms.2023.158.162
URL: https://www.makhillpublications.co/view-article/1815-9346/10.59218/makrjms.2023.158.162