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Neurol Med Chir (Tokyo). 1993 Jan;33(1):13-8.

Acute subdural hematoma: severity of injury, surgical intervention, and mortality.

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Department of Neurosurgery, Juntendo University Urayasu Hospital, Urayasu, Chiba.


Sixty patients with acute subdural hematoma were treated at Tokyo Metropolitan Hiroo Hospital between 1981 and 1989. The overall mortality was 55% and the functional recovery rate 30%. Thirteen (93%) of 14 patients with a Glasgow Coma Scale (GCS) score of 3 died, while all eight patients with a GCS score of 7 or more achieved functional recovery. The mortality of patients with GCS scores of 4-6 ranged from 45 to 67%. Patients with GCS scores of 4-6 over 65 years old had a mortality of 82%, compared to 50% mortality for those aged 19-40 years. The mortality for patients with GCS scores of 4-6 operated on within 4 hours of injury was 62% in contrast to 33% for those operated on from 4 to 10 hours. Patients with GCS scores of 4-6 who underwent craniotomy with evacuation of the hematoma achieved significantly better recovery than those treated by burr holes. Four patients with GCS scores of 4-6 died in spite of decompressive craniectomy or craniotomy with duroplasty. The mortality is only influenced by age and type of surgical intervention among patients with GCS scores of 4-6. Shorter time from injury to surgical evacuation does not affect mortality within 10 hours of injury.

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