A Prospective Study on Acute Subdural Hematoma in Mild Head Injury Patients: Outcome with Initial Nonoperative Management

Introduction Incidence of acute subdural hematoma (SDH) is 21% in head injury patients. Decompressive craniectomy done for acute SDH itself carries a very high morbidity and mortality. The skull bone defect, prolonged hospital stay, the need of a second surgery (cranioplasty), and bone flap infection are other problems associated with decompressive craniectomy. Hence, this study looks into the outcome of conservative management in acute SDH in patients with mild head injury. Aims and Objectives The main objective of this article is to study the patients included in the study with regard to outcome, morbidity, duration of hospital stay, and hospital cost. This article also studies the efficacy and outcome of lesser aggressive management (burr-hole evacuation) after initial nonoperative management of the patients included in the study. Materials and Methods This is a prospective study performed in the Department of Neurosurgery, Gauhati Medical College and Hospital. A total of 30 patients arriving in the emergency department during a 6-month period from December 1, 2017 to May 31, 2018 with a diagnosis of acute SDH and with Glasgow coma scale (GCS) 13 to 15 were evaluated. Evaluation was done by history, clinical examination, GCS, computed tomography (CT) (plain) scan brain, and Glasgow outcome score at 6 months follow-up. Results and Observations Twenty patients showed complete resolution of the clot, and eight patients had liquefaction of clot which was evacuated by burr-hole. One mortality was recorded and one had to undergo decompressive craniectomy. About 93.33% of patients managed by initial nonoperative management showed functionally independent outcome at 6 months follow-up. Conclusion Conservative management in patients with acute SDH can be a viable alternative in certain cases. Those patients with GCS of 13 and above with CT scan showing midline shift of even >= 5 mm or thickness of 10 mm and more can also be managed conservatively by close monitoring.