376 Prognosis in Patients Presenting with Non-Reactive Pupils with a Chronic Subdural Haematoma

Abstract

Abstract Introduction Chronic subdural haematoma (CSDH) is a common neurosurgical pathology which is increasing in prevalence due to the ageing population. Predicting neurological outcome from defined metrics following surgery for CSDH is key to defining a neuroprognostic tool. Non-reactive pupils, due to coma, is recognised as an indicator of raised intracranial pressure (ICP) and poorer neurological outcome. There remains limited evidence defining its exact effect on outcome in patients with CSDH. Method Data from 1278 patients surgically managed for CSDH between 2009 and 2019 were retrospectively reviewed. Those with a GCS of 8 or less pre-operatively were identified (n = 77). These patient’s pupillary response at presentation, inpatient mortality, and Glasgow Outcome Score (GOS) on discharge were recorded from electronic and paper notes. Results 8 patients (10.3%) had a non-reactive pupil at presentation. 4 patients with an unreactive pupil died as inpatients (50% mortality) versus 2 with bilaterally reactive pupils (2.8%) (p<0.01). Overall, only 1 survivor with non-reactive pupils had a good neurological outcome (GOS 4 or 5) meaning 7 or 87.5% had a poor neurological outcome (GOS 1-3) (p = 0.03). This compares to 35 patients or 50.7% having a poor neurological outcome in the bilaterally reactive pupil group. There is a statistically significant difference in mortality and morbidity in patients with a non-reactive pupil. Conclusions An unreactive pupil is a poor prognostic indicator of morbidity and mortality in patients presenting with CSDH.