Prognosis

Acute subdural hematoma (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][128]​​​​​​[129][130]​​​​[131][132][133]​​ Among all patients with acute SDH, fewer than 25% ultimately achieve a full recovery without any major neurologic deficit.[3][128][133][134][135][136]

Poorer functional outcomes are associated with:

  • older age;​[3][132]

  • greater severity of injury;[137]

  • lower score on the GCS;​[135][138][139]

  • brain imaging findings of midline shift, multiple parenchymal lesions, and obliteration of the basal, ambient, or quadrigeminal cistern;[137][140]

  • early need for surgery;[134] and

  • elevated intracranial pressure.​[134][137]

Severity of injury and pupillary response have been reported as the best discriminating factors for predicting outcome.[137][132]

One study showed patients with nontraumatic SDH have significantly higher cumulative rates of hospital readmission, surgical hematoma evacuation, and in-hospital death at 90 days compared with patients with traumatic SDH.[141]​ These outcomes may be influenced by a heightened short-term risk of an acute ischemic 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.[142]

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][143]​​​​ The recurrence rate of chronic SDH necessitating re-intervention varies from 9% to 33%.[26][144]​​​ Prognostic factors include the admission GCS score, radiographic features (e.g., midline shift and neomembranes), and the type of surgical intervention the patient received.[145]​ Over half of patients with chronic SDH show a significantly worse cognitive status 3 months after treatment (surgery +/- dexamethasone) compared with healthy controls.[146]

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