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Updated: May 2, 2026
09:01
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
8.4K
Acute Surgery vs Conservative Treatment for Traumatic Acute Subdural Hematoma
Thomas A Van Essen1,2,3,4, John K Yue3,4, Jason Barber5
1University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center & Haga, Leiden-The Hague, the Netherlands.
JAMA Network Open
|October 3, 2025
Summary
Surgery for acute subdural hematoma (ASDH) and traumatic brain injury (TBI) showed similar outcomes to conservative treatment. Center preference for surgery did not improve results, suggesting conservative care may be considered when outcomes are uncertain.
Area of Science:
- Neurosurgery
- Trauma Care
- Clinical Effectiveness Research
Background:
- The optimal treatment strategy for acute subdural hematoma (ASDH) following traumatic brain injury (TBI) remains unclear.
- Comparing surgical evacuation versus conservative management is crucial for patient outcomes.
Purpose of the Study:
- To compare the effectiveness of acute surgical ASDH evacuation versus initial conservative treatment.
- To analyze the impact of center-specific treatment preferences on patient outcomes.
Main Methods:
- A prospective observational study involving 18 US Level 1 trauma centers.
- Included patients with nonpenetrating TBI and ASDH detected on CT scan.
- Functional outcomes at 6 months assessed using the Glasgow Outcome Scale-Extended.
Main Results:
- Of 711 patients with ASDH, 21% underwent acute surgery and 79% received conservative treatment.
- Significant variation in acute surgery rates (0%-86%) observed across centers.
- Center preference for surgery was not associated with improved functional outcomes (OR, 1.05).
Conclusions:
- Similar patient outcomes were observed between centers preferring surgical evacuation and those preferring conservative treatment.
- Center-specific treatment preferences for ASDH management did not influence patient outcomes.
- Conservative treatment may be a viable option for ASDH patients when neurosurgeons face clinical equipoise.
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