Survival Trends After Surgery for Acute Subdural Hematoma in Adults Over a 20-year Period.

Accepted version
Repository DOI

Change log
Fountain, Daniel M 
Kolias, Angelos G 
Lecky, Fiona E 
Bouamra, Omar 
Lawrence, Thomas 

OBJECTIVE: We sought to determine 30-day survival trends and prognostic factors following surgery for acute subdural hematomas (ASDHs) in England and Wales over a 20-year period. SUMMARY OF BACKGROUND DATA: ASDHs 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 yrs) treated surgically between 1994 and 2013. Two thousand four hundred ninety-eight 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 (<2 m 34%, >2 m 24%), road traffic collision (25%), and other (17%). Thirty-six per cent of patients presented with polytrauma. Gross survival increased from 59% in 1994 to 1998 to 73% in 2009 to 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.

Adult, Age Factors, Aged, Cause of Death, Cohort Studies, Craniotomy, Databases, Factual, Female, Follow-Up Studies, Glasgow Coma Scale, Hematoma, Subdural, Acute, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Propensity Score, Quality Improvement, Retrospective Studies, Risk Assessment, Sex Factors, Survival Rate, Time-to-Treatment, Treatment Outcome, United Kingdom
Journal Title
Ann Surg
Conference Name
Journal ISSN
Volume Title
Ovid Technologies (Wolters Kluwer Health)
TCC (None)
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.