Conservative management outcomes of traumatic acute subdural hematomas.

BACKGROUND Traumatic brain injury represents a significant cause of mortality and permanent disability in the adult population. Acute subdural hematoma is one of the conditions most strongly associated with severe brain injury. Knowledge on the natural history of the illness and the outcomes of patients conservatively managed may help the neurosurgeon in the decision-making process. METHODS We present the clinical course and outcomes of a group of 38 patients with traumatic acute subdural hematomas conservatively treated. Outcomes analysis taking into consideration age, Glasgow Coma Scale scores on admission, and radiological findings is provided. RESULTS Patients less than 65 years old had a favorable or functionally independent outcome in 85% of the cases. Patients with Glasgow Coma Scale scores greater than 8 had a functionally independent outcome in 78% of the cases. Patients with acute subdural hematomas with thicknesses < or = 10 mm and midline shifts < or = 5 mm showed functionally independent outcomes in 82% of the cases. CONCLUSION The conservative management of patients with acute subdural hematomas can be a viable alternative in certain cases. Those patients younger than 65 years old, with small acute subdural hematomas and Glasgow Coma Scale scores greater than 8, will have the best functional outcomes.