Predictors of outcome in acute subdural hematoma with severe head injury- A prospective study

Acute subdural hematoma(SDH) is an uncommon condition, however, SDH associated with cerebral contusion or laceration is more frequent. Acute SDH still carry a high mortality and morbidity. This paper is a prospective analysis of 61 acute SDH patients admitted over 1 year period. Glasgow Coma Score of all the patients was 8 or less. Thickness of SDH, midline shift, associated pathology along with clinical parameters were correlated with outcome. While all the patients were ventilated, patients with significant mass lesion and midline shift were subjected to surgery. Forty percent patients were under 40 years of age and 85% patients were involved in vehicular accidents. Nine patients were M1 (motor response), 30 patients had bilateral fixed dilated pupils and 8 patients had unilateral dilated pupils. Overall survival was recorded in 21 patients (34.6%) and16.6% patients with bilateral dilated pupils survived. Young age, bilaterally reacting pupils, normal cold caloric response and midline shift less than 5 mm were good prognostic factors. Only 2 out of 21 patients with diffuse cerebral swelling survived. None of our patients with shock survived. Our study brings out the factors, which influence the outcome in patients with acute SDH.