Operative Timing in Patients with Traumatic Acute Subdural Hematomas.
- Author:
Gui Woong PARK
1
;
Seong Beom OH
;
Ik Pom KIM
;
Hyuk Sang KOH
;
Yong Hae OH
;
Deok Soo CHOI
;
Hee Jeong PARK
;
Il Kug CHOI
Author Information
1. Department of Emergency Medicine, College of Medicine, Dankook University, Cheoan, Korea. holytiger@hanmail.net
- Publication Type:Original Article
- Keywords:
Hematoma;
Subdural;
Mortality
- MeSH:
Brain Injuries;
Craniocerebral Trauma;
Hematoma;
Hematoma, Subdural;
Hematoma, Subdural, Acute;
Humans;
Logistic Models;
Odds Ratio;
Retrospective Studies
- From:Journal of the Korean Society of Emergency Medicine
2008;19(6):678-685
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Acute traumatic subdural hematoma (SDH) increases after severe traumatic brain injury (TBI) and leads to high mortality. The time to operation is a correctable prognostic factor in TBI, but the timing of hematoma evacuation still remains controversial. We assessed the correlation between operative timing and mortality in traumatic acute SDH. METHODS: We conducted a retrospective study over an 8-year period in 163 surgical patients with acute traumatic SDH. Information was obtained about demographic, clinical, and radiological findings, surgical management, and mortality at discharge. RESULTS: Overall, 85 patients (52.1%) died, and 47 patients (28.8%) showed good recovery. The patients who underwent earlier surgery were more likely to have severe head injury. The time to operation in patients that died was shorter than patients with good recovery. The mean time for evacuation [Ed-Is this the same as time to surgery, or is this specifically when the hematoma was removed? Please clarify.] was 351.7+/-220.5 minutes in patients who died and 395.5+/-363.3 minutes in patients with good recovery. Patients undergoing surgery within 4 hours of injury had a mortality rate of 54.4% versus 50.9% receiving surgery after 4 hours. But the risk ratio for time spent to surgery increased until 240 minutes and then decreased. Logistic regression on patients with 240 minutes until surgery showed that the probability of death increased with time to surgery. CONCLUSION: Patients who undergo surgery within 180 minutes after injury have a lower probability of death than those with delayed surgery.
