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Shedding new light on rapidly resolving traumatic acute subdural hematomas
Magdalene Brooke1, Atul Patel2, Federico Castro-Moure2
1Department of Surgery, University of California San Francisco East Bay, Oakland, California.
The Journal of Surgical Research
|October 29, 2017
Summary
Rapidly resolving acute subdural hematomas (RRASDHs) were studied in 154 patients. Lower comorbidities and anticoagulation were noted in resolving cases, but RRASDHs did not improve trauma outcomes.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Radiology
Background:
- Rapidly resolving acute subdural hematomas (RRASDHs) are poorly understood despite case reports.
- Previous studies suggested predictors like coagulopathy and intracranial hemorrhage.
- Hypothesized that rapid resolution correlates with better trauma outcomes.
Purpose of the Study:
- To confirm predictors of RRASDH.
- To investigate the association between RRASDH and trauma outcomes.
- To analyze a cohort of patients with acute subdural hematomas.
Main Methods:
- Retrospective review of 154 nonoperative acute subdural hematoma (ASDH) cases (2011-2015).
- Inclusion criteria: ASDH on CT, GCS >7, repeat CT for change evaluation.
- RRASDH defined as ≥50% thickness reduction within 72 hours; analyzed clinical data and CT findings.
Main Results:
- 29 cases of RRASDH identified among 154 patients.
- RRASDH group showed lower comorbidities (58.6% vs 78.4%) and prehospital anticoagulation (7.7% vs 37.1%).
- No difference in previously reported predictors or standard trauma outcomes; RRASDH group had lower mortality than rapid growth group (3.4% vs 23.5%).
Conclusions:
- This is the largest review of RRASDHs to date.
- Identified potential new predictors but confirmed previously reported ones were not associated with resolution.
- Found no link between RRASDH and improved standard trauma outcomes, questioning its clinical significance.
