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Traumatic acute subdural hematoma: major mortality reduction in comatose patients treated within four hours.

Abstract
To discover which factors contributed to recovery after surgical intracranial decompression, we reviewed the records of 82 consecutive comatose patients with traumatic acute subdural hematoma (ASDH) who were treated in a single center under a uniform protocol. The delay from injury to operation was the factor of greatest therapeutic importance. Patients who underwent surgery within the first four hours had a 30 per cent mortality rate, as compared with 90 percent in those who had surgery after four hours (P less than 0.0001). Other important prognostic variables included results of the initial neurologic examination, sex, multimodality-evoked potentials, and postoperative intracranial pressure (ICP). If all patients with traumatic ASDH were taken directly to hospitals equipped to diagnose and remove the hematoma within four hours of injury, mortality rates could be reduced considerably.
AuthorsJ M Seelig, D P Becker, J D Miller, R P Greenberg, J D Ward, S C Choi
JournalThe New England journal of medicine (N Engl J Med) Vol. 304 Issue 25 Pg. 1511-8 (Jun 18 1981) ISSN: 0028-4793 [Print] United States
PMID7231489 (Publication Type: Comparative Study, Journal Article, Research Support, U.S. Gov't, P.H.S.)
Topics
  • Accidents, Traffic
  • Acute Disease
  • Adult
  • Analysis of Variance
  • Brain Injuries (complications, surgery)
  • Coma (etiology, mortality, surgery)
  • Craniotomy
  • Evoked Potentials
  • Female
  • Hematoma, Subdural (etiology, mortality, surgery)
  • Humans
  • Intracranial Pressure
  • Male
  • Time Factors

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