Survival Trends after Surgery for Acute Subdural Hematoma in Adults over a 20-Year Period
Fountain, Daniel M
Lecky, Fiona E
Annals of Surgery
MetadataShow full item record
Fountain, D. M., Kolias, A., Lecky, F. E., Bouamra, O., Lawrence, T., Adams, H., Bond, S., & et al. (2016). Survival Trends after Surgery for Acute Subdural Hematoma in Adults over a 20-Year Period. Annals of Surgery https://www.repository.cam.ac.uk/handle/1810/253827
Objective – We sought to determine 30-day survival trends and prognostic factors following surgery for acute subdural hematomas (ASDH) in England and Wales over a 20 year period. Summary Background Data – Acute subdural hematomas are still considered the most lethal type of traumatic brain injury. It remains unclear whether the adjusted odds of survival have improved significantly over time. Methods – Using the Trauma Audit and Research Network (TARN) database, we analyzed ASDH cases in the adult population (>16 years) treated surgically between 1994 and 2013. 2,498 eligible cases were identified. Univariable and multiple logistic regression analyses were performed, using multiple imputation for missing data. Results – The cohort was 74% male with a median age of 48.9 years. Over half of patients were comatose at presentation (53%). Mechanism of injury was due to a fall (<2m 34%, >2m 24%), road traffic collision (25%), and other (17%). 36% of patients presented with polytrauma. Gross survival increased from 59% in 1994-1998 to 73% in 2009-2013. Under multivariable analysis, variables independently associated with survival were: year of injury, Glasgow Coma Scale, Injury Severity Score, age and pupil reactivity. The time interval from injury to craniotomy and direct admission to a neurosurgical unit were not found to be significant prognostic factors. Conclusions – A significant improvement in survival over the last 20 years was observed after controlling for multiple prognostic factors. Prospective trials and cohort studies are expected to elucidate the distribution of functional outcome in survivors.
trauma, traumatic brain injury, neurosurgery, craniotomy
AGK is supported by a Royal College of Surgeons of England Research Fellowship, a National Institute for Health Research (NIHR) Academic Clinical Fellowship, and a Raymond and Beverly Sackler Studentship. PJH is supported by a NIHR Research Professorship and the NIHR Cambridge Biomedical Research Centre.
This record's URL: https://www.repository.cam.ac.uk/handle/1810/253827
Attribution-NonCommercial-NoDerivatives 4.0 International
Licence URL: http://creativecommons.org/licenses/by-nc-nd/4.0/