TIMING OF SURGICAL INTERVENTION IN ACUTE SUBDURAL HEMATOMAS: A CLINICAL OUTCOME STUDY

Abstract

Background: Acute subdural hematoma (ASDH) is a life-threatening neurosurgical emergency. The timing of surgical intervention plays a crucial role in determining neurological outcomes and survival. Aim: To evaluate the impact of the timing of surgical intervention on clinical outcomes in patients with ASDH. Materials and Methods: This prospective observational study was conducted in the Department of Neurosurgery, G. R. Medical College and J. A. Group of Hospitals, Gwalior (M.P.), from June 2020 to July 2021. A total of 80 patients with radiologically confirmed ASDH who underwent surgical evacuation were included. Patients were divided into three groups based on the timing of surgery: early (<6 hours), intermediate (6–12 hours), and late (>12 hours). Outcomes were assessed using the Glasgow Outcome Score (GOS) at discharge and at the 3-month follow-up. Results: Early surgical intervention was associated with significantly better outcomes, with 68% of patients undergoing early surgery showing a favorable GOS (4–5), compared to 42% in the intermediate surgery group and 18% in the late surgery group. Mortality was lowest in the early surgery group (12%) and highest in the late group (41%). Favorable outcomes were also significantly associated with higher initial GCS and bilateral reactive pupils. Conclusion: Timely surgical intervention, especially within 6 hours of injury, is critical in improving survival and neurological recovery in ASDH patients. Early decision-making and rapid surgical response should be prioritized in all suspected cases.