gms | German Medical Science

Objective: Acute subdural hematoma (aSDH) is a life-threatening condition urging immediate surgery. To assess the role of decompressive craniectomy (DC) in the treatment of aSDH especially in geriatric patients, a retrospective single centre study was conducted with respect to patients' survival and outcome at discharge.

Method: The medical records of 306 patients with aSDH treated between 2004 and 2013 were retrospectively analysed. Patients aged > 75 years receiving DC were included for study purposes. Initial GCS, pupil status, initial computed tomography (CT) scan and INR were obtained from the records as well as GOS on discharge and latest follow-up, if available.

Results: A total of 48 patients were identified meeting inclusion criteria for the present study. Initial GCS was 3-15. 45/48 patients (94%) presented with a midline shift on admission CT. 27 patients (56%) had pupillary anomalies. 32 patients (67%) died despite instant DC. Only three patients reached GOS of 1 or 2 during follow-up, while mean GOS was 3 at discharge and last follow-up.

Conclusions: The overall mortality is high in geriatric patients suffering from aSDH, leaving the majority of survivors with unfavorable outcomes (GOS 3 or 4). In our study, only pupil status and initial GCS were predictive for survival of the patients. DC did not improve the outcome in elderly patients. These data should be taken into account for the indication of an operation.