Clinical and radiological features predicting outcome of operated acute subdural hematoma.

Abstract

Objective: Acute subdural hematoma (ASDH) is a common and life-threatening complication of traumatic brain injury, with high mortality despite surgical evacuation. Clinical and radiological factors influencing outcome remain incompletely defined in low- and middle-income settings. Study Design: Prospective Observational study. Setting: Lady Reading Hospital, Peshawar, Pakistan. Period: July 2024 to June 2025. Methods: 116 consecutive patients aged 2–65 years undergoing surgery for traumatic ASDH. Patients requiring conservative management, expiring before surgery, or with significant comorbidities were excluded. Data on demographics, Glasgow Coma Scale (GCS) at presentation, pupillary reactivity, hematoma thickness, midline shift, and in-hospital mortality were collected. Frequencies, means/medians, chi-square/Fisher's exact tests, and multivariable logistic regression were used for analysis. Results: Of 116 patients, in-hospital mortality was 48.3% (56/116). Mean age was 38.4 ± 16.2 years; 78% were male. Road traffic accidents caused 62% of cases. Median GCS was 7 (IQR 5–9); 52% had non-reactive pupils at presentation. Mean hematoma thickness was 18.6 ± 6.4 mm; mean midline shift was 9.8 ± 4.7 mm. Mortality was significantly higher with GCS ≤8 (62.9% vs. 18.2%, p<0.001), non-reactive pupils (71.7% vs. 23.2%, p<0.001), hematoma thickness ≥15 mm (64.8% vs. 21.4%, p<0.001), and midline shift ≥10 mm (70.9% vs. 25.0%, p<0.001). Multivariable analysis confirmed GCS ≤8 (OR 5.42, 95% CI 2.18–13.48), non-reactive pupils (OR 6.81, 95% CI 2.76–16.79), and midline shift ≥10 mm (OR 4.17, 95% CI 1.68–10.34) as independent predictors. Conclusion: In-hospital mortality after surgical evacuation of traumatic ASDH was 48.3%, with low GCS, fixed pupils, and significant midline shift independently predicting poor outcome. These factors can guide prognostication and resource allocation in resource-limited settings.