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Natural Course of Initially Non-Operated Cases of Acute Subdural Hematoma : The Risk Factors of Hematoma Progression

OBJECTIVE: The objectives of the present study were to characterize the natural course of initially non-operated traumatic acute subdural hematoma (ASDH) and to identify the risk factors of hematoma progression. METHODS: Retrospective analysis was performed using sequential computed tomography (CT)...

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Autores principales: Son, Seong, Yoo, Chan Jong, Lee, Sang Gu, Kim, Eun Young, Park, Chan Woo, Kim, Woo Kyung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Neurosurgical Society 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3836928/
https://www.ncbi.nlm.nih.gov/pubmed/24278650
http://dx.doi.org/10.3340/jkns.2013.54.3.211
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author Son, Seong
Yoo, Chan Jong
Lee, Sang Gu
Kim, Eun Young
Park, Chan Woo
Kim, Woo Kyung
author_facet Son, Seong
Yoo, Chan Jong
Lee, Sang Gu
Kim, Eun Young
Park, Chan Woo
Kim, Woo Kyung
author_sort Son, Seong
collection PubMed
description OBJECTIVE: The objectives of the present study were to characterize the natural course of initially non-operated traumatic acute subdural hematoma (ASDH) and to identify the risk factors of hematoma progression. METHODS: Retrospective analysis was performed using sequential computed tomography (CT) images maintained in a prospective observational database containing 177 ASDH cases treated from 2005 to 2011. Patients were allocated to four groups as followings; 136 (76.8%) patients to the spontaneous resolution group, 12 (6.8%) who underwent operation between 4 hours and 7 days to the rapid worsening group (RWG), 24 (13.6%) who experienced an increase of hematoma and that underwent operation between 7 and 28 days to the subacute worsening group (SWG), and 5 (2.8%) who developed delayed aggravation requiring surgery from one month after onset to the delayed worsening group (DWG). Groups were compared with respect to various factors. RESULTS: No significant intergroup difference was found with respect to age, mechanism of injury, or initial Glasgow Coma Scale. The presence of combined cerebral contusion or subarachnoid hemorrhage was found to be a significant prognostic factor. Regarding CT findings, mixed density was common in the RWG and the SWG. Midline shifting, hematoma thickness, and numbers of CT slices containing hematoma were significant prognostic factors of the RWG and the SWG. Brain atrophy was more severe in the SWG and the DWG. CONCLUSION: A large proportion of initially non-operated ASDHs worsen in the acute or subacute phase. Patients with risk factors should be monitored carefully for progression by repeat CT imaging.
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spelling pubmed-38369282013-11-25 Natural Course of Initially Non-Operated Cases of Acute Subdural Hematoma : The Risk Factors of Hematoma Progression Son, Seong Yoo, Chan Jong Lee, Sang Gu Kim, Eun Young Park, Chan Woo Kim, Woo Kyung J Korean Neurosurg Soc Clinical Article OBJECTIVE: The objectives of the present study were to characterize the natural course of initially non-operated traumatic acute subdural hematoma (ASDH) and to identify the risk factors of hematoma progression. METHODS: Retrospective analysis was performed using sequential computed tomography (CT) images maintained in a prospective observational database containing 177 ASDH cases treated from 2005 to 2011. Patients were allocated to four groups as followings; 136 (76.8%) patients to the spontaneous resolution group, 12 (6.8%) who underwent operation between 4 hours and 7 days to the rapid worsening group (RWG), 24 (13.6%) who experienced an increase of hematoma and that underwent operation between 7 and 28 days to the subacute worsening group (SWG), and 5 (2.8%) who developed delayed aggravation requiring surgery from one month after onset to the delayed worsening group (DWG). Groups were compared with respect to various factors. RESULTS: No significant intergroup difference was found with respect to age, mechanism of injury, or initial Glasgow Coma Scale. The presence of combined cerebral contusion or subarachnoid hemorrhage was found to be a significant prognostic factor. Regarding CT findings, mixed density was common in the RWG and the SWG. Midline shifting, hematoma thickness, and numbers of CT slices containing hematoma were significant prognostic factors of the RWG and the SWG. Brain atrophy was more severe in the SWG and the DWG. CONCLUSION: A large proportion of initially non-operated ASDHs worsen in the acute or subacute phase. Patients with risk factors should be monitored carefully for progression by repeat CT imaging. The Korean Neurosurgical Society 2013-09 2013-09-30 /pmc/articles/PMC3836928/ /pubmed/24278650 http://dx.doi.org/10.3340/jkns.2013.54.3.211 Text en Copyright © 2013 The Korean Neurosurgical Society http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Article
Son, Seong
Yoo, Chan Jong
Lee, Sang Gu
Kim, Eun Young
Park, Chan Woo
Kim, Woo Kyung
Natural Course of Initially Non-Operated Cases of Acute Subdural Hematoma : The Risk Factors of Hematoma Progression
title Natural Course of Initially Non-Operated Cases of Acute Subdural Hematoma : The Risk Factors of Hematoma Progression
title_full Natural Course of Initially Non-Operated Cases of Acute Subdural Hematoma : The Risk Factors of Hematoma Progression
title_fullStr Natural Course of Initially Non-Operated Cases of Acute Subdural Hematoma : The Risk Factors of Hematoma Progression
title_full_unstemmed Natural Course of Initially Non-Operated Cases of Acute Subdural Hematoma : The Risk Factors of Hematoma Progression
title_short Natural Course of Initially Non-Operated Cases of Acute Subdural Hematoma : The Risk Factors of Hematoma Progression
title_sort natural course of initially non-operated cases of acute subdural hematoma : the risk factors of hematoma progression
topic Clinical Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3836928/
https://www.ncbi.nlm.nih.gov/pubmed/24278650
http://dx.doi.org/10.3340/jkns.2013.54.3.211
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