Turkish Neurosurgery 2002 , Vol 12 , Num 3-4
PROGNOSTIC VALUE OF INITIAL COMPUTED TOMOGRAPHY FINDINGS IN PATIENTS WITH TRAUMATIC ACUTE SUBDURAL HEMATOMA
İhsan SOLAROĞLU, Erkan KAPTANOĞLU, Özerk OKUTAN, Etem BEŞKONAKLI, Yamaç TAŞKIN
Ankara Numune Research and Teaching Hospital, Department of Neurosurgery Objective: The prognostic value of initial computed tomography (CT) findings in cases of traumatic acute subdural hematoma (ASDH) is unclear. The aim of this study was to investigate relationships between initial CT findings and outcome in this patient group.

Methods: Sixty-five cases of traumatic ASDH were retrospectively analyzed. Of these, 20 were selected based on two main criteria: initial Glasgow Coma Scale score <10, and time from trauma to surgery <4 hours. All 20 patients received the same medication and underwent the same surgical procedures. Initial CT findings of hematoma thickness, midline shift, subarachnoid hemorrhage (SAH), basal cistern obliteration (BCO), intra parenchymal hematoma and contusion (IPH/C) in the same hemisphere, and calculated brain-swelling factor (BSF) were assessed in each case. Neurological (functional) outcome was evaluated with the Glasgow Outcome Scale, and mortality rates related to the different parameters were calculated.

Results: The overall rates of mortality and functional recovery were 75% and 25%, respectively. Initial CT findings of greater midline shift, BCO, IPH/C, and BSF were associated with poor outcome.

Conclusions: BSF is one of the most important predictors of prognosis in patients with traumatic ASDH. On initial CT in this patient group, hematoma thickness and presence of SAH are not accurate indicators of outcome. Keywords : Acute subdural hematoma, computed tomography, outcome

Corresponding author : İhsan Solaroğlu, isolaroglu@yahoo.com