Outcome after acute traumatic subdural haematoma in Kenya: a single-centre experience

Abstract

Background Acute subdural haematoma (ASDH) is one of the most common traumatic neurosurgical emergencies with a high mortality rate. However, few studies have examined prognostic factors of outcome in isolated traumatic ASDH.
Methods We reviewed the records of patients who were diagnosed with traumatic ASDH between January 2000 and December 2009. Analysis was carried out using Statistical Package for Social Sciences (SPSS) version 11.5 and multivariate logistic regression analysis used to evaluate the influence of clinical variables on outcome.
Results A total of 259 patients were diagnosed with acute subdural hematomas during the study period. The mean age was 41.1 years + 19.659 and 223 (86.1%) were men while 36 (13.9%) were women. The most common cause of injury was assault (44.8%) with road traffic and falls accounting for 24.7% and 30.5%. Fifty two patients (20.1%) died while hospitalized while good functional recovery was attained by 118 (45.6%). Patients aged older than 61 years had a significantly higher mortality rate (30.6%) and a lower rate of good functional recovery (24.5%) (P=0.073). Of the patients with GCS scores <8, 38 (65.5%) died as compared to 4 (3.5%) deaths in patients with scores ranging from 13 to 15. Further, a history of loss of consciousness and the length of time between the injury and operative decompression significantly influenced the final outcome.
Conclusion An increased risk of death occurs in patients who are over 61 years of age and have lower preoperative GCS, the presence of pupillary abnormalities and a long interval between trauma and decompression. The findings would help clinicians determine management criteria and improve survival.