Timing of Surgery as a Predictor of Outcome in Traumatic Acute Subdural Hematoma

Objectives: To determine if reducing the time from trauma to surgery is associated with decreased mortality in patients with traumatic acute subdural hematomas. Background: It remains controversial whether decreasing the time from trauma to surgical intervention is associated with increased survival in patients with traumatic acute subdural hematomas. Materials and Methods: This is a prospective study of 8 months from August 2013 to April 2014 conducted at the Department of Neurosurgery, PGMI / Lahore General Hospital, Lahore. Adult patients in whom surgical evacuation of acute subdural hematoma was carried out were included in the study. Age / Sex, presenting Glasgow Coma Scale (GCS) and the time passed from trauma to the start of the surgery was noted. The outcome of the patients was categorized according to the Glasgow Outcome Scale.Results: Forty eight adult patients meeting the inclusion criteria were included in the study. There were 36 males and 12 females. The mortality for patients operated within four hours was 83.3% compared to 75% for patients operated within four to ten hours, and 73.1% for patients operated after ten hours. Two patients (12.5%) in the four to ten hour group, and five patients (19.2%) in the group of patients operated after ten hours had a favourable outcome. Surprisingly, this showed a trend that increased time from trauma to surgery led to a better outcome. However, patients operated early also had more severe neurological injury.Conclusion: A shorter time from injury to surgical evacuation does not decrease mortality in traumatic acute subdural hematoma