The Westmead head injury project: Outcome prediction in acute subdural haematoma

A prospective two year study of a consecutive sample of patients with an acute subdural haematoma who were admitted to Westmead Hospital, New South Wales, Australia was undertaken. There were 103 patients with an acute subdural haematoma admitted in the period. Twenty-four of these scored 9 or greater on the Glasgow Coma Scale (GCS) and of these all made a functional recovery, i.e. Glasgow Outcome Scale (GOS 1 or 2). The remaining 79 patients scored 8 or less on admission and of these 30% made a functional recovery. Of the 70% remaining, 4% were moderately or severely disabled (GOS 3 or 4) while 66% died (GOS 5). Age, hypoxia, hypotension, response to intracranial pressure control and two CT scan features, midline shift as measured from the septum pellucidum and cerebral oedema, were all significant in predicting outcome. Time from injury to treatment, initial pupil response, lucid interval and compression of brainstem cisterns on CT scans statistically failed to predict outcome. The data were analysed using logistic regression which showed age and midline shift to predict death or disability with an accuracy of 80% at twelve months after the injury (sensitivity 58%, specificity 89%).