Acute Subdural Hematoma Management in the Emergency Department
Main Article Content
Abstract
Acute subdural hematoma (ASDH) is a serious and potentially life-threatening condition that requires prompt and effective management in the emergency department (ED). This review article aims to provide an overview of the current evidence-based management strategies for ASDH in the ED setting. The article begins by discussing the pathophysiology of ASDH, emphasizing the rapid accumulation of blood between the dura mater and the arachnoid membrane following a traumatic brain injury. This can lead to increased intracranial pressure and potentially fatal brain herniation if not promptly addressed. The review then outlines the initial assessment and resuscitation of patients with suspected ASDH in the ED. The article then delves into the specific management strategies for ASDH in the ED, including the role of neurosurgical consultation, and the potential need for emergent surgical intervention to evacuate the hematoma and relieve pressure on the brain. In conclusion, this review article provides a comprehensive overview of the current evidence-based management of ASDH in the ED, emphasizing the importance of prompt recognition, accurate diagnosis, and timely intervention to optimize patient outcomes.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
- Professional, C. C. M. (n.d.). Subdural Hematoma. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21183-subdural-hematoma
- Ryan, C. G., Thompson, R. E., Temkin, N. R., Crane, P. K., Ellenbogen, R. G., & Elmore, J. G. (2012). Acute traumatic subdural hematoma: current mortality and functional outcomes in adult patients at a Level I trauma center. The journal of trauma and acute care surgery, 73(5), 1348–1354. https://doi.org/10.1097/TA.0b013e31826fcb30
- Saatman, K. E., Duhaime, A. C., Bullock, R., Maas, A. I., Valadka, A., Manley, G. T., & Workshop Scientific Team and Advisory Panel Members (2008). Classification of traumatic brain injury for targeted therapies. Journal of neurotrauma, 25(7), 719–738. https://doi.org/10.1089/neu.2008.0586
- Pierre, L., & Kondamudi, N. P. (2018). Subdural hematoma.
- Tenny, S., & Thorell, W. (2017). Intracranial hemorrhage.
- Hung K. L. (2020). Pediatric abusive head trauma. Biomedical journal, 43(3), 240–250. https://doi.org/10.1016/j.bj.2020.03.008
- Marbacher, S., Fandino, J., & Lukes, A. (2010). Acute subdural hematoma from ruptured cerebral aneurysm. Acta neurochirurgica, 152(3), 501–507. https://doi.org/10.1007/s00701-009-0521-0
- Unnithan, A. K. A., & Mehta, P. (2020). Hemorrhagic stroke.
- Magid-Bernstein, J., Girard, R., Polster, S., Srinath, A., Romanos, S., Awad, I. A., & Sansing, L. H. (2022). Cerebral Hemorrhage: Pathophysiology, Treatment, and Future Directions. Circulation research, 130(8), 1204–1229. https://doi.org/10.1161/CIRCRESAHA.121.319949
- Rajashekar, D., & Liang, J. W. (2020). Intracerebral hemorrhage.
- Professional, C. C. M. (n.d.). Hemorrhagic Stroke. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/23969-hemorrhagic-stroke
- Articles. (n.d.). https://www.cedars-sinai.org/health-library/diseases-and-conditions/s/subdural-hematoma.html
- Joyce, T., Gossman, W., & Huecker, M. R. (2023). Pediatric Abusive Head Trauma. In StatPearls. StatPearls Publishing.
- Rao, M. G., Singh, D., Vashista, R. K., & Sharma, S. K. (2016). Dating of Acute and Subacute Subdural Haemorrhage: A Histo-Pathological Study. Journal of clinical and diagnostic research : JCDR, 10(7), HC01–HC7. https://doi.org/10.7860/JCDR/2016/19783.8141
- Walter, T., Meissner, C., & Oehmichen, M. (2009). Pathomorphological staging of subdural hemorrhages: statistical analysis of posttraumatic histomorphological alterations. Legal medicine (Tokyo, Japan), 11 Suppl 1, S56–S62. https://doi.org/10.1016/j.legalmed.2009.01.112
- Ayaz, H., Izzetoglu, M., Izzetoglu, K., Onaral, B., & Ben Dor, B. (2019). Early diagnosis of traumatic intracranial hematomas. Journal of biomedical optics, 24(5), 1–10. https://doi.org/10.1117/1.JBO.24.5.051411
- Leung, G. K., Ng, G. K., Ho, W., Hung, K. N., & Yuen, W. K. (2012). Impact of a multidisciplinary trauma team on the outcome of acute subdural haematoma. Injury, 43(9), 1419–1422. https://doi.org/10.1016/j.injury.2011.03.017
- Atalay, T., Ak, H., Gülsen, I., & Karacabey, S. (2019). Risk factors associated with mortality and survival of acute subdural hematoma: A retrospective study. Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 24, 27. https://doi.org/10.4103/jrms.JRMS_14_16
- Dixon, J., Comstock, G., Whitfield, J., Richards, D., Burkholder, T. W., Leifer, N., Mould-Millman, N. K., & Calvello Hynes, E. J. (2020). Emergency department management of traumatic brain injuries: A resource tiered review. African journal of emergency medicine : Revue africaine de la medecine d'urgence, 10(3), 159–166. https://doi.org/10.1016/j.afjem.2020.05.006
- Sahni, R., & Weinberger, J. (2007). Management of intracerebral hemorrhage. Vascular health and risk management, 3(5), 701–709.
- Alarcon, J. D., Rubiano, A. M., Okonkwo, D. O., Alarcón, J., Martinez-Zapata, M. J., Urrútia, G., & Bonfill Cosp, X. (2017). Elevation of the head during intensive care management in people with severe traumatic brain injury. The Cochrane database of systematic reviews, 12(12), CD009986. https://doi.org/10.1002/14651858.CD009986.pub2
- Koyfman, A. (n.d.). Acute Subdural Hematoma Management in the ED: Practice Essentials, Emergency Department Management, Neurosurgical Consultation. https://emedicine.medscape.com/article/828005-overview#a2
- Ivascu, F. A., Janczyk, R. J., Junn, F. S., Bair, H. A., Bendick, P. J., & Howells, G. A. (2006). Treatment of trauma patients with intracranial hemorrhage on preinjury warfarin. The Journal of trauma, 61(2), 318–321. https://doi.org/10.1097/01.ta.0000223944.25922.91
- Gerard, C., & Busl, K. M. (2014). Treatment of acute subdural hematoma. Current treatment options in neurology, 16(1), 275. https://doi.org/10.1007/s11940-013-0275-0
- Hanger, H. C., Geddes, J. A., Wilkinson, T. J., Lee, M., & Baker, A. E. (2013). Warfarin-related intracerebral haemorrhage: better outcomes when reversal includes prothrombin complex concentrates. Internal medicine journal, 43(3), 308–316. https://doi.org/10.1111/imj.12034
- Yamamura, H., Morioka, T., Yamamoto, T., & Mizobata, Y. (2016). Head computed tomographic measurement as a predictor of outcome in patients with subdural hematoma with cerebral edema. Scandinavian journal of trauma, resuscitation and emergency medicine, 24, 83. https://doi.org/10.1186/s13049-016-0271-y
- Brouwers, H. B., & Goldstein, J. N. (2012). Therapeutic strategies in acute intracerebral hemorrhage. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 9(1), 87–98. https://doi.org/10.1007/s13311-011-0091-8
- Ahmed, N., Greenberg, P., & Shin, S. (2021). Mortality Outcome of Emergency Decompressive Craniectomy and Craniotomy in the Management of Acute Subdural Hematoma: A National Data Analysis. The American surgeon, 87(3), 347–353. https://doi.org/10.1177/0003134820951463
- Zumofen, D., Regli, L., Levivier, M., & Krayenbühl, N. (2009). Chronic subdural hematomas treated by burr hole trepanation and a subperiostal drainage system. Neurosurgery, 64(6), 1116–1122. https://doi.org/10.1227/01.NEU.0000345633.45961.BB
- Shin, D. S., & Hwang, S. C. (2020). Neurocritical Management of Traumatic Acute Subdural Hematomas. Korean journal of neurotrauma, 16(2), 113–125. https://doi.org/10.13004/kjnt.2020.16.e43
- Karibe, H., Hayashi, T., Hirano, T., Kameyama, M., Nakagawa, A., & Tominaga, T. (2014). Surgical management of traumatic acute subdural hematoma in adults: a review. Neurologia medico-chirurgica, 54(11), 887–894. https://doi.org/10.2176/nmc.cr.2014-0204