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Acute Traumatic Subdural Hematomas-When (and Why) Do We Stop? The aSDH-stop Survey
Lidia Dias1, Paulo Nogueira2,3,4,5, João Pedro Oliveira1
1Department of Neurosurgery, Hospital Egas Moniz - Unidade Local de Saúde de Lisboa Ocidental, Lisboa, Portugal.
Summary
Neurosurgeons often consider non-classical factors beyond guidelines when deciding on surgery for Acute Subdural Hematomas (ASDH). These factors, including reflexes and comorbidities, influence decisions for poor-prognosis cases.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Clinical Decision-Making
Background:
- Acute Subdural Hematoma (ASDH) management guidelines exist.
- Non-classical prognostic factors may influence surgical decisions.
- Brain Trauma Foundation (BTF) guidelines are a reference.
Purpose of the Study:
- Investigate neurosurgeons' decision-making in ASDH surgical management.
- Assess the role of non-classical BTF factors (e.g., reflexes, comorbidities) alongside traditional guidelines.
- Examine demographic correlations with decision-making.
Main Methods:
- International survey of neurosurgeons.
- Presentation of real-case ASDH scenarios.
- Assessment of traditional and non-traditional prognostic indicators' impact.
- Collection of demographic data.
Main Results:
- 67 neurosurgeons from 22 countries responded.
- Non-classical BTF factors were relied upon for poor-prognosis ASDH cases.
- No significant correlation found between decision-making and surgeon demographics.
Conclusions:
- ASDH surgical decision-making is complex and nuanced.
- Non-traditional prognostic factors are important in practice.
- Further research is needed to refine clinical guidelines for comprehensive patient care.
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