Shirzad Azhari, Hosein Safdari, Massoud Shabehpoor, Hosein Nayebaghaie, Zohreh Amiri,
Volume 12, Issue 4 (2-1999)
Abstract
To determine the factors affecting the outcome of patients with traumatic acute
subdural hematoma, we reviewed the records of7 4 consecutive comatose patients
with a Glascow coma scale Score (GCS) of less than 8 who had been admitted to
Imam Hosein Medical Center from 1990 to 1996 and had undergone a uniform
treatment protocol.
The overall mortality rate was 73% and 23% had functional recovery, but 4%
were severely disabled or vegetative. The following variables had a statistically
significant correlation with poor outcome: age over 65 years (p<0.05), preoperative
GCS of 3 or 4 (p<0.05), bilateral absent pupillary light reflexes (p<0.05), and
immediate and sustained coma from the moment of injury to operation without any
lucid interval (p<0.00l). The time interval between injury and operation, sex,
mechanism of injury, and associated craniocerebral injuries were not significantly
correlated with outcome. In patients with immediate post-traumatic
unconsciousness, the extent of primary brain injury is the crucial factor to predict
the outcome. However, in patients with a lucid interval, the mass effect of
hematoma seems to be more important, therefore prompt surgical decompression
in addition to management of secondary brain insults improves the outcome
remarkably.
