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Traumatic subdural haematoma: integrating case-based clinical judgement with guidelines
Aditya Samitinjay1, Satya Revanth Karri2, Praveen Khairkar2
1Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India.
BMJ Case Reports
|September 8, 2020
Summary
Severe traumatic brain injury (TBI) in a young man, initially indicated for surgery, was successfully managed conservatively. This case challenges standard guidelines, showing good recovery is possible with clinical judgment in resource-limited settings.
Area of Science:
- Neurosurgery
- Traumatology
- Clinical Case Study
Background:
- Traumatic brain injury (TBI) is a major cause of death and disability globally, with road accidents being the most frequent cause.
- Severe TBI often necessitates emergency surgical intervention, such as decompressive surgery, as recommended by guidelines like the Brain Trauma Foundation (BTF).
Observation:
- A 23-year-old male presented with severe TBI and subdural hematoma in a comatose state.
- Despite being a candidate for emergency decompressive surgery per BTF guidelines, conservative management was chosen.
Findings:
- The patient, managed conservatively, demonstrated a remarkable recovery.
- Achieved a perfect Glasgow Outcome Scale Extended Score of 8/8, indicating a full return to function.
Implications:
- This case questions the universal applicability of strict BTF guidelines for severe TBI, especially in rural Indian hospitals.
- Highlights the importance of clinical judgment and literature review in managing severe TBI when surgical resources or adherence to guidelines may be limited.
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