Servadai reviewed prognostic factors in adults who develop acute subdural hematoma after severe head injury. This can help identify those patients who may require more aggressive management and monitoring. The author is from Ospedale M. Bufalini in Italy.
Parameters:
(1) age
(2) pupillary responses
(3) Glasgow coma score (GCS)
(4) presence of a lucid interval with coma
(5) post-operative intracranial pressure (ICP) monitoring
(6) hematoma volume (CT scan)
(7) midline shift (CT scan)
(8) intradural lesions (contusions, etc.) (CT scan)
(9) compression of basal cistern (CT scan)
(10) treatment facility
|
Parameters |
Good |
Fair |
Poor |
|
age |
< 50 |
50 - 65 |
> 65 |
|
pupillary responses |
both reactive |
one nonreactive |
both nonreactive |
|
GCS |
> 8 |
4-8 |
3 |
|
coma |
none |
lucid interval |
no lucid interval |
|
ICP monitoring |
< 20 mm Hg |
20-45 mm Hg |
> 45 mm Hg or uncontrollable |
|
hematoma volume |
< 25 mL |
25 - 100 mL |
> 100 mL |
|
midline shift |
none |
small |
large |
|
intradural lesion |
none |
small contusion or cerebral lesion |
large contusion or cerebral lesion |
|
basal cisterns |
not compressed |
|
bilateral compressed or absent |
|
treatment facility |
neurosurgical trauma center |
|
small hospital with general surgeon |
where:
• There was conflicting data on the impact of age. I tried to set values as best I could.
• The size of the midline shift varied in different studies.
Other factors that may affect prognosis:
(1) The interval between injury and treatment has been reported by some to affect prognosis, but the type of treatment center appears to be more important.
(2) The type of surgical procedure may affect outcome but no clear pattern was identified.
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general, Otolaryngology
ICD-10: ,
