Analysis of presurgery time as a prognostic factor in traumatic acute subdural hematoma

Head trauma is the most commonly seen trauma mechanism which has the highest mortality rate in traffic accident. More than 1000 cases are registered every year in our institution. The mechanical forces applied to the head can create simple wound, skull fracture, and intracranial bleeding. Many factors affect the outcome. Mortality rate of acute traumatic subdural hematoma (ASDH) can reach 40-90%. Despite the principle of "golden hour" for ASDH patients, there is niehter no evidence to support it nor any surgeon management to duplicate. The purpose of this study was to analyze the presurgery time, i.e., the time elapsed from the accident to the definitive treatment, as a prognostic factor that might influence the mortality rate of traumatic acute subdural hematoma.

Consecutive patients who underwent surgical intervention for traumatic ASDH between April 2009 and April 2011 were enrolled in the study. Their data were collected and classified into variables. Statistical measure using multivariate logistic regression was applied to search any relationship between presurgery time and patients' outcome.

The study enrolled 93 patients, mostly male (75.3%). There were 6 cases of mild head injury, 28 of moderate and 58 of severe injury. Time passed between accident and operation, in overall, was 19.6 hours, with a range between 4-54 hours.

Many factors affect the outcome of ASDH. Rapid transport to hospital with neurosurgery facility was associated with better outcomes. Being retrospective, this study has its own limitation. Future studies should recruit a larger number of patients.