Risk Factors of Delayed Surgical Intervention after Conservatively Treated Acute Traumatic Subdural Hematoma

Abstract

Objective: Although acute subdural hematoma (ASDH) has been thought as a disease which should be managed surgically, some of those cases might be treated conservatively. However, some of those who managed ASDH with conservative treatment require surgical intervention later. The aim of this study is to evaluate the predictable factors which make ASDH patients who initially manage conservatively undergo delayed surgical intervention. Methods: From Jan 2007 to Dec 2015, 842 patients were treated in diagnosis of ASDH in our institution. Among these, 158 patients of convexity ASDH initially treated conservatively. Patients were divided into delayed surgical group and conservative group. Demographics, past medication and medical histories, radiologic and laboratory data were collected by retrospective chart review. Univariate and multivariate analyses were utilized to identify independent risk factors. Results: Twenty eight patients (17.7%) underwent delayed surgical intervention. Mean age was 69.0 years and 82.1% was male. Prevalence of HTN, DM, and heart disease or usage of anti-platelet agent were not significantly different from conservative group. However, age (p = 0.024), previous cerebral infarction history (p = 0.026), increased maximal thickness of hematoma (p < 0.001), midline shifting (p = 0.001) and accompanied SAH (p = 0.022) on initial brain CT scan, low hemoglobin level (p < 0.001), high leukocyte count (p = 0.004), and low glucose level (p = 0.002) showed significantly associated with delayed surgical intervention. In multivariate analysis, increased maximal thickness of hematoma (OR = 1.279, 95 % CI 1.075 - 1.521; p = 0.006), low hemoglobin level (OR = 0.673, 95 % CI 0.467 - 0.970; p = 0.034), and high leukocyte count (OR = 1.142, 95 % CI 1.024 - 1.272; p = 0.017) were found to be the independent risk factors. Conclusion: Because of high chance to get delayed surgical intervention in minimal ASDH patients with thicker hematoma in initial brain CT, lower hemoglobin level, and higher leukocyte count, those patients have to get more careful observation.