Prognosis

Acute subdural haematoma (SDH)

Acute SDH is associated with mortality rates as high as 50% to 90% in patients who present with Glasgow Coma Scale (GCS) scores of 8 or less.[3][127][128]​​​​​[129][130]​​​[131][132]​ Among all patients with acute SDH, fewer than 25% ultimately achieve a full recovery without any major neurological deficit.[3][127][132][133][134][135]

Poorer functional outcomes are associated with:

  • older age;​[3][131]

  • greater severity of injury;[136]

  • lower score on the GCS;​[134][137][138]

  • imaging findings of midline shift, multiple parenchymal lesions, and obliteration of the basal, ambient, or quadrigeminal cistern;[136][139]

  • early need for surgery;[133] and

  • raised intracranial pressure.​[133][136]

Severity of injury and pupillary response have been reported as the best discriminating factors for predicting outcome.​[131][136]

One study showed patients with non-traumatic SDH have significantly higher cumulative rates of hospital re-admission, surgical haematoma evacuation, and in-hospital death at 90 days compared with patients with traumatic SDH.[140]​ These outcomes may be influenced by a heightened short-term risk of an acute ischaemic stroke in the first 4 weeks after SDH compared with patients without SDH. This increased risk may be driven by interruption of antithrombotic therapy after SDH diagnosis.[141]

Chronic SDH

Although chronic SDH is not often acutely fatal, it is associated with significant morbidity and disability.[36]​ A diagnosis of chronic SDH is a significant predictor of mortality, with an overall survival of approximately 4 years from diagnosis.[36][142]​​​​ The recurrence rate of chronic SDH necessitating re-intervention varies from 9% to 33%.[26][143]​​​ Prognostic factors include the admission GCS score, radiographic features (e.g., midline shift and neomembranes), and the type of surgical intervention the patient received.[144]​ Over half of patients with chronic SDH show a significantly worse cognitive status 3 months after treatment (surgery +/- dexamethasone) compared with healthy controls.[145]

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