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  • Title: Criteria for conservative treatment of supratentorial acute subdural haematomas.
    Author: Wong CW.
    Journal: Acta Neurochir (Wien); 1995; 135(1-2):38-43. PubMed ID: 8748790.
    Abstract:
    Without mortality, 31 patients underwent conservative treatment for traumatic supratentorial acute subdural haematoma (SDH). Later on six of them had the haematoma surgically evacuated mainly because of a deterioration of the Glasgow Coma Scale (GCS) scores. It was found that patients with a midline shift of less than 10 mm on the computed tomography (CT) scans and with a GCS score of 15 initially might be treated conservatively under close observation, reserving urgent craniotomy and evacuation of the SDH for those with deteriorating neurological conditions. A smaller degree of midline shift was tolerated by patients with an GCS score of less than 15: a shift of more than 5 mm on the initial CT scans predicted an exhaustion of the cerebral compensatory mechanism within 3 days of injury. In such cases the GCS score worsened, and surgical evacuation of the SDH became necessary. A total hospital stay of 6 to 7 days may suffice for those who have become fully conscious. Repeat CT studies before discharge should be done and a close follow-up during the first 3 to 4 weeks is advisable.
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