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58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

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A change in the cause of acute subdural hematomas: positive effects due to increased road traffic safety

Ursachen des akuten Subduralhämatoms: positive Veränderungen auf Grund einer gestiegenen Verkehrssicherheit

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  • corresponding author L. Dörner - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel
  • H. Barth - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel
  • H. M. Mehdorn - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocFR.02.04

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2007/07dgnc069.shtml

Published: April 11, 2007

© 2007 Dörner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The subdural hematoma (SDH) is the major outcome-defining factor in traumatic brain injury. This is mostly due to a parenchymal distorsion as the primary pathophysiological basis. So far motor vehicle accidents have been described as the main cause of SDH. The aim of this study was to look at the epidemiology of SDH with decreasing casualties and improving safety standards concerning the road traffic in developed countries.

Methods: The charts of 260 patients admitted to our hospital with acute and subacute SDH from 1994 to 2003 were retrospectively analyzed for the clinical presentation at admittance, the clinical course and the outcome measured with the Glasgow Outcome Score (GOS). Special interest was taken by looking at the cause and the special features of the causing road traffic accidents.

Subsequently the cranial computer tomograms were evaluated for the thickness of the hematoma, the degree of brain shift and parenchymal lesions.

Results: By far the most frequent cause of SDH were falls (75%), followed by participants of road traffic accidents not using motor vehicles (MV, 12%) and passengers of MV (9%). Most of the casualties of traffic accidents were pedestrians, cyclists not wearing helmets and passengers in cars with unfastened seat belts or air bags. More than 40 % of the injuries occurred under the influence of alcohol and other drugs. Significant prognostic factors for survival were the age, pupil width on admission and midline deviation.

Conclusions: There is a significant change in the causes of acute and subacute SDH. It is not the road traffic accidents but other falls that are the main cause of SDH admitted to our hospitals. The casualties with severe traumatic brain injuries or acute subdural hematomas in traffic accidents are predominantly pedestrians, cyclists and passengers with low safety measures. It seems that the improving safety of MV is showing results.

As a conclusion, further safety measures in particular the consistent use of cycle helmets are to be recommended.