tra umatic acute subdural hematoma: analysis of factors afecting outcome in comatose patients

to determine the factors affecting the outcome of patients with traumatic acute subdural hematoma, we reviewed the records of7 4 consecutive comatose patients with a glascow coma scale score (gcs) of less than 8 who had been admitted to imam hosein medical center from 1990 to 1996 and had undergone a uniform treatment protocol. the overall mortality rate was 73% and 23% had functional recovery, but 4% were severely disabled or vegetative. the following variables had a statistically significant correlation with poor outcome: age over 65 years (p<0.05), preoperative gcs of 3 or 4 (p<0.05), bilateral absent pupillary light reflexes (p<0.05), and immediate and sustained coma from the moment of injury to operation without any lucid interval (p<0.00l). the time interval between injury and operation, sex, mechanism of injury, and associated craniocerebral injuries were not significantly correlated with outcome. in patients with immediate post-traumatic unconsciousness, the extent of primary brain injury is the crucial factor to predict the outcome. however, in patients with a lucid interval, the mass effect of hematoma seems to be more important, therefore prompt surgical decompression in addition to management of secondary brain insults improves the outcome remarkably.