COMPUTED TOMOGRAPHIC CRITERIA AND SURVIVAL RATE FOR PATIENTS WITH ACUTE SUBDURAL-HEMATOMA

OBJECTIVE: Computed tomographic data from 174 patients with acute subd ural hematoma were analyzed statistically to identify parameters that could be evaluated independently of clinical and neurological status t o estimate outcome. METHODS: This retrospective study was made necessa ry by the fact that the patients admitted usually had been treated wit h intubation, sedation, and artificial ventilation, which precludes ne urological examination. RESULTS: In surgically treated patients, the h ematoma thickness ranged from 5 to 35 mm and the midline shift was 0 t o 33 mm. In 81 patients (46.6%), the hematoma thickness was greater th an the midline shift; in 24 patients (13.8%), the hematoma thickness e qualed the midline shift; and in 69 patients (39.6%), the midline shif t exceeded the hematoma thickness. Of the patients, 52% died after sur gery, for 29% we obtained good or satisfying results, and 19% were in poor condition after therapy. The Kaplan-Meier survival analysis prove d that the survival rate was only 50% for a hematoma thickness of appr oximately 18 mm and a midline shift of 20 mm. The survival function dr opped markedly for midline shifts of more than 20 mm and converged to 0% for midline shifts of more than 25 mm. If the midline shift exceede d the hematoma thickness by 3 mm, the survival function was 50%; when the midline shift exceeded the hematoma thickness by 5 mm, the surviva l function was 25%. The Glasgow Outcome Scale scores were correlated s ignificantly with these parameters. The parameters, which are the meas ured hematoma thickness, the midline shift, and the difference between the hematoma thickness and the midline shift, allow robust/adequate e stimation of survival function and outcome for patients suffering from acute subdural hematoma. CONCLUSION: Eased on these data, indications for surgery could be assessed by means of video conferencing, i.e., w ithout personal examination of the patients.