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Comparison of two surgical techniques in the management of acute SDH
EANS Academy. Anis S. Sep 27, 2019; 275950; EP14004
Abstract
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Objective: To determine the outcomes and predictors of survival after acute traumatic subdural hematoma following craniotomy/decompressive craniectomy.
Methods: A Retrospective cohort was done over 16 years (2000-2015) including all adult patients (age >17 years) who sustained acute traumatic brain injury resulting in subdural Hematoma (ASDH) requiring surgery (Craniotomy vs DC). Patients with other significant traumatic brain injury (contusions, extradural hematoma), spontaneous bleed, systemic injuries were excluded. Data analysis was done SPSS. P< 0.05 were considered significant.
Results: A total of 165 patients were included with the majority were male (87.9%).Patients who underwent a craniotomy were significantly older than patients who underwent a craniectomy. There were also significant differences in the ER to OR shifting time, Marshal Grade, total time for surgery, ICU stay, SCU stay and post-operative GCS. Furthermore, when a comparison was made between type of surgery and mortality, there was no relation between mortality and type of surgery performed (p=0.138). Overall survival rate was 75.2% ,which was only found to be significant for age and presenting GCS when divided categorically based on Kaplan meier survival analysis. Patient's age, ER to OR interval and blood loss were found to be statistically significant independent factors on multivariate analysis.
Conclusion: The study suggests younger age, less ER to OR interval and less blood loss in a setting of acute SDH are associated with improved outcomes. A lower presenting and discharging GCS is associated with poor prognosis. Higher marshall score, young age and prolonged surgery favors Decompressive craniectomy (DC). Higher mortality with increasing age, higher marshall score and low presenting GCS. Type of surgery does not affect mortality and other post-operative outcome.
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