Multicenter study: Functional outcome and associated factors of operated traumatic acute subdural hematoma patients

Abstract

Abstract Introduction: Acute subdural hematoma (ASDH) is the most common and devastating lesions in traumatic brain injury with mortality rate of 60%. Several factors have been implicated in the prognosis of ASDH. Include GCS, pupillary abnormalities, MAP, respiratory rate, glycemic status, length of hospital stay, hypoxia, presence or absence of a subarachnoid bleed, and intraventricular hemorrhage. The development computed tomography (CT), intracranial pressure (ICP) monitoring, specialized trauma centers and ICU management and surgical technique has been shown to reduce the mortality rate of ASDH. The aim of the study was to determine associated factors those related to surgical intervention in resource limited set up and used us a learning curve for all stake holders involved in the management of a patient. Objective: To assess functional outcome and associated factors of operated ASDH patients at multicenter, Addis Ababa, Ethiopia Method: A multicenter analytic cross-sectional study was conducted to assess functional outcome of operated ASDH patients and associated factors at three centers Addis Ababa, Ethiopia. A total of 140 patients were admitted and operated for ASDH in all participating centers between January 1, 2018 and January 1, 2021G.C. From this 115 charts were reviewed with checklist and phone interview. Data regarding sociodemographic data, factors affecting outcome including patient factors and treatment related factors and functional outcome in GOSE and mortality were gathered. Independent t-test, chi-square test was used for the comparison of variables in the favorable and unfavorable outcome groups. A multivariable logistic regression was performed to identify independent clinical factors associated with functional outcome. Result: A total of 115 patients with mean age of 35.91 were included in this study. Male predominate 87% and assault 35.7% was the most common mechanism of injury. Sixty five (56.5%) of patients achieved favorable functional recovery (EGOS of 5 or 8) and 50(43.5%) of patients had unfavorable recovery (EGOS of 1–4) after 6 month of follow-up. GCS 5 and below, Pupillary light response, MAP, oxygen saturation at presentation and HAP was the independent factors associated with functional outcome in multivariate logistic regression models. Conclusion and Recommendation: The rate of unfavorable outcomes in acute subdural hematoma is high. GCS 5 and below, pupillary light response, MAP, oxygen saturation at presentation and postoperative HAP complications are important predictor for functional outcome. We recommend emergent surgical management for those with lower GCS, hypotensive and desaturating at presentation and standard management of postoperative complication. Time frame: Feb 2022 to Aug 2022 Key words: functional outcome, Glasgow coma scale, Extended Glasgow outcome scale, acute subdural hematoma