Revisiting the Surgical Outcomes of Non-Acute Subdural Hematomas among Retired Military Personnel : A Single Tertiary Hospital Retrospective Analysis in the Philippines.

OBJECTIVE

Subdural hematomas (SDHs) are classified clinically and/or radiologically as acute SDH (ASDH), subacute SDH (SSDH), and chronic SDH (CSDH). The management differ depending on their classification, with only the ASDH having a definite accepted surgical guideline. Non-acute SDH, specifically SSDH and CSDH have no clear surgical guidelines but are managed similarly in some literature. This study was conducted to determine if there is a difference in outcomes among surgically managed non-acute SDH in a specific elderly population of retired military personnel.

METHODS

This is a pre-pandemic retrospective study that utilized data obtained from January 2016 to April 2019, in a subspecialty tertiary hospital that caters to retired military personnel or veterans, in the Philippines. After chart review and application of inclusion and exclusion criteria, 21 patients were included, all military retirees, with age 56 years old and above. Chart review and electronic database were retrieved to extract relevant information.

RESULTS

In this study, a term 'mixed-type subdural hematoma' (MSDH) was proposed to encompass SDH that have mixed hypo-andhyperdensity on preoperative computed tomography scan and were subsequently found to have bright red liquefied hematoma instead of the classic engine machinery oil fluid found in a CSDH. Based on the observed cohort, nine out of 11 CSDH patients attained the Glasgow outcome scale extended (GOS-E) score of 8 while all the respondents in the MSDH group attained the same GOS-E score underscoring the need for early intervention in patients with non-acute SDH. Moreover, the outcomes of both MSDH and CSDH are comparable with low mortality rate (approximately 9.5%) and immediate postoperative improvement (approximately 90%).

CONCLUSION

MSDH and CSDH, although classified separately using clinical and/or radiologic means, can collectively be categorized as a non-acute SDH and can be managed safely and effectively with burr hole surgery.