What is the mortality rate for subdural hematoma (SDH)?

Updated: Jul 26, 2018
  • Author: Richard J Meagher, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

In a retrospective review of 109 consecutive patients with head injury with a CT scan diagnosis of acute traumatic subdural hematoma, Phuenpathom et al found that poor outcome was strongly correlated with the best sum GCS score within the first 24 hours of head injury and pupillary inequality. Age and pupillary reaction to light also correlated well with the outcome.

The mortality in the whole series was 50%, and mortality for all 37 patients with a GCS score of 3 was 100% (this rate decreased as the GCS increased). The mortality for those with unequal pupils was 64%, versus 40% for those with equal pupils. The mortality associated with one nonreactive pupil was 48%, versus 88% with bilateral nonreactive pupils. The outcome status of the patients with bilateral nonreactive pupils who survived was not noted. [19]

Wilberger et al also found an 88% mortality associated with fixed, dilated pupils and noted a 7% functional recovery in survivors with this finding. This study found that neurologic presentation and postoperative ICP (which was not evaluated by Phenpatham et al) were strong predictors of outcome. Wilberger et al also found a trend of increasing mortality rate with age, although it was not statistically significant. [16]

A review by Sakas et al of 1-year outcomes following craniotomy for traumatic hematomas in patients with fixed, dilated pupils suggested that the presence of an acute subdural hematoma was the single most important predictor of a negative outcome. Patients with subdural hematomas had a mortality of 64%, compared with a mortality of 18% in patients with extradural hematomas. [20]

Seelig et al also showed that neurologic examination findings and postoperative ICP were important prognostic factors. The peak ICP was less than 20 mm Hg in 53% of patients with acute traumatic subdural hematoma (similar to 59% of patients with other types of head injuries), but this group accounted for 79% of the patients with functional recoveries.

All patients with uncontrollably elevated ICP (>60 mm Hg) died. These authors claimed a 25% functional recovery rate (defined by the Glasgow Outcome Scale) in patients presenting with fixed, dilated pupils. [21]

Acute subdural hematomas that would otherwise be considered operative by imaging criteria may resolve on their own, although this is rare. A series of 4 such patients was reported by Kapsalaki et al. [22]

No clear prognostic factors are associated with chronic subdural hematoma. While some authors have found an association with preoperative level of neurological function and outcome, others have not. Early diagnosis before significant neurologic deterioration may correlate with a more favorable prognosis. No correlation has been found between preoperative CT scan findings and postoperative outcome.

The mortality within 30 days of surgery is 3.2-6.5%. Eighty percent of patients resume their prehematoma level of function. Sixty-one percent of patients aged 60 years or younger and in 76% of patients older than 60 years have favorable outcomes. In a relatively recent series, 89.4% of patients with chronic SDH who were treated with a closed drainage system had a good recovery and 2.2% worsened. [23]

Mori et al found that old age, pre-existing cerebral infarction, and subdural air after surgery correlated with poor brain expansion. [24] Stanisic et al reported a 14.9% postoperative recurrence rate; various factors were associated with this. [24]


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