362 Neurological Outcomes in Patients Presenting with a Low GCS Due to CSDH

Abstract

Abstract Introduction Chronic Subdural Haematoma (CSDH) is a common neurosurgical pathology. Neuroprognostication remains a challenge and evidence remain limited, particularly in patients presenting with a low GCS (8 or lower). Further clarification on neuroprognostication is important to inform surgical decision making. Method 1278 patients who had CSDH surgically evacuated were retrospectively reviewed for GCS at presentation. 77 patients with GCS of 8 or less were detected. Mortality at discharge and 6 months, GCS, Glasgow Outcome Score (GOS) on discharge, discharge destination and other relevant clinical information were recorded from their paper and electronic notes. Results 35 patients (45.4%) had a good neurological outcome (GOS 4 or 5). Inpatient mortality was 7.8% (n = 6). 6-month all-cause mortality was 20.7% (n = 16). Only 21.1% were discharged directly to their usual place of residence, with the remainder being discharged to local hospitals or rehabilitation units. Overall GCS (p = 0.003) and motor score (p = 0.013) at presentation was significantly associated with neurological outcome. Only overall GCS was associated with inpatient mortality (p = 0.037) but there was no association with mortality at 6 months (p = 0.603). Conclusions GCS of 8 or less in patients with CSDH is an important finding, with significant subsequent neurological morbidity and mortality. Although it is not the only prognostic indicator, a large number of patients had a good outcome despite this, indicating that intervention is not futile in all.