Emergency presentation of subdural hematoma: a review of 85 cases diagnosed by computerized tomography

The emergency presentations of 85 patients diagnosed by computerized axial tomography (CT) as having subdural hematomas (SDH) were retrospectively reviewed to identify factors contributing to an early or delayed diagnosis. Sixty-one of 85 patients (72%) were diagnosed within 24 hours of presentation. Forty-five of 57 (79%) with definite history or signs of cranial trauma were diagnosed within 24 hours, while only 16 of 28 (57%) without historical or physical evidence of trauma were diagnosed promptly. Focal neurologic signs were present in 32 of 57 patients (56%) with head trauma and 24 of these patients (75%) had an early CT scan. Twenty-two of 50 patients (44%) with head trauma had skull fractures, but the presence or absence of skull fracture alone did not serve to hasten the diagnosis in this group. In patients without head trauma, 14 of 28 (50%) had focal neurologic signs, with eight of 14 (57%) undergoing CT scan within 24 hours. No patient in this group had an abnormal skull series. Thus despite the immediate availability of CT scanning, a significant number of patients, especially those without history or evidence of head trauma, had a delay in diagnosis exceeding 24 hours. The presence of a focal neurologic sign is a more sensitive indicator of the presence of SDH than is a positive skull series.