Treatment decision making in acute subdural haematoma

Abstract

What factors influence decision making when a patient with traumatic brain injury is considered for neurosurgery? Most traumatic brain injuries are of mild severity, and neurosurgical intervention for these cases is rarely indicated. In patients with more severe traumatic brain injuries, the brain is often diffusely affected, without a focal neurosurgical target. For a proportion of patients, however, brain imaging identifies a localised haematoma, whereby timely surgical blood evacuation can be lifesaving. Unfortunately, the evidence base to guide decision making for patients with a haematoma is weak. Surgery versus conservative treatment for traumatic acute subdural haematoma: a prospective, multicentre, observational, comparative effectiveness studyOur findings show that treatment for patients with acute subdural haematoma with similar characteristics differed depending on the treating centre, because of variation in the preferred approach. A treatment strategy preferring an aggressive approach of acute surgical evacuation over initial conservative treatment was not associated with better functional outcome. Therefore, in a patient with acute subdural haematoma for whom a neurosurgeon sees no clear superiority for acute surgery over conservative treatment, initial conservative treatment might be considered. Full-Text PDF