Midline Shift and Haematoma Thickness as a Prognostic Factor of Mortality in Patients with Acute Subdural Haematoma

Abstract

Introduction: Acute Subdural Haematoma (ASDH) is a type of intracranial haematoma, which has the highest mortality rate. The ASDH generally presents as a secondary consequence of Traumatic Brain Injury (TBI) and can be classified as traumatic or non traumatic and acute or chronic. Aim: To assess the Midline Shift (MLS) and Subdural Haematoma (SDH) thickness as a prognostic factor of mortality on initial cranial Computed Tomography (CT) scan of patients with ASDH. Materials and Methods: This cross-sectional study analysed the computed CT of 61 patients who were admitted due to traumatic SDH in Sri Devaraj Urs Medical College, Kolar, Karnataka, India. Thickness of MLS (mm) and SDH (mm) were estimated from the CT scan (SIEMENS SOMATOM Emotion 16 Slice) of patients admitted during the study period from June to August 2021. The thickness of the SDH and MLS were compared separately with the survival status. The Area Under the Curve (AUC) was estimated from the Receiver Operating Characteristic (ROC) curve. The sensitivity, specificity, predictive values and diagnostic accuracy of the screening test along with their 95% Confidence Interval (CI) were presented. The p-value <0.05 was considered statistically significant. Results: The predictive validity of MLS (mm) was excellent (AUC=0.936) and that of SDH thickness (mm) was fair (AUC=0.799) in predicting survival. The cut-off value derived from the ROC curve for MLS was 3.95 mm and for SDH thickness was 3.35 mm; above which the number of people died was more and was statistically significant (p<0.001). The sensitivity and specificity of the MLS in predicting the survival was 90.32% and 90.00%, respectively and sensitivity and specificity of the SDH thickness was 74.19% and 76.67%, respectively. Conclusion: The sensitivity and specificity of MLS was found to be superior when compared to the SDH thickness. The cut- off value derived from ROC curve for MLS was 3.95 mm and for SDH was 3.35 mm, above which the chance of survival was poor.