Traumatic acute subdural hematoma and coma: retrospective cohort of surgically treated patients

BACKGROUND: A subdural hematoma is defined as clot formation in the subdural space after vessel rupture or brain parenchyma damage. Several demographic and tomographic factors were associated to poor prognosis, although some debate according to their specific roles still remains. METHODS: Retrospective cohort study of comatose patients admitted to a single-institution, tertiary hospital center, between the years 2013 and 2019 with traumatic acute subdural hematoma requiring surgical evacuation were studied. Demographic and tomographic data were obtained from medical records. Univariate and multivariate statistical analysis were performed, using a value of P < 0.05 for significance. RESULTS: Seventy-seven patients were selected using the criteria and a total of 37 (48%) head CT exams were evaluated. The overall mortality was 57.1% and achieved 100% at ≥75-years-old subgroup. Univariate analysis only found young age as a good prognosis factor (P = 0.002). Gender (P = 0.784), abnormal pupillary response (P = 0.643), midline shift (P = 0.874), clot thickness (P = 0.206), compressed basal cisterns (P = 0.643), hematoma side (P = 0.879), and subarachnoid hemorrhage (P = 0.510) showed no association. Multivariate analysis showed no statistically significant association between covariates. CONCLUSION: Traumatic acute subdural hematoma is a life-threatening condition. Younger age was the only positive prognostic factor identified. More research is necessary to establish age as a rule-out criterion to surgical indication.