Predictors of Postoperative Neurological Outcome After Surgical Evacuation of Traumatic Acute Subdural Hematoma: A Retrospective Cohort Study
8 affiliations
- 1Department of Anatomy, Lahore Medical and Dental College, Lahore, PAK
- 2Department of Biochemistry, Lahore Medical and Dental College, Lahore, PAK
- 3Department of Medical Sciences, Lahore Medical and Dental College, Lahore, PAK
- 4Department of Neurosurgery, Ghurki Trust Teaching Hospital, Lahore, PAK
- 5Department of Surgery, Ghurki Trust Teaching Hospital, Lahore, PAK
- 6Department of Medicine, Amna Inayat Medical College, Lahore, PAK
- 7Department of Medical Sciences, Al-Aleem Medical College, Lahore, PAK
- 8Department of Medical Sciences, Affiliated Hospital of Hebei University of Engineering, Handan, CHN
Abstract
Background
Traumatic acute subdural hematoma (ASDH) is a severe consequence of traumatic brain injury and is associated with substantial mortality and neurological disability among surgically treated patients.Objective
To identify clinical, physiological, radiological, and operative factors associated with unfavorable three-month neurological outcome and to support risk stratification among patients undergoing surgical evacuation of traumatic ASDH.Methods
This retrospective cohort study included 120 adults who underwent surgical evacuation of traumatic ASDH at Ghurki Trust Teaching Hospital, Lahore, between March 2025 and March 2026. Demographic, clinical, radiological, and perioperative variables were evaluated. The primary outcome was unfavorable neurological status at three months, defined as a Glasgow Outcome Scale-Extended (GOSE) score of 1-4. Multivariable logistic regression was used to identify factors independently associated with unfavorable outcomes. As all participants underwent surgery and no non-operative comparison group was included, the study was designed to evaluate prognostic associations rather than the effect of surgical evacuation itself.Results
The mean age was 50.8 ± 17.9 years; 75 (62.5%) patients were male, and 45 (37.5%) were female. An unfavorable neurological outcome occurred in 74 (61.7%) patients, and three-month mortality was 21.7% (26/120). Factors independently associated with unfavorable outcome were admission Glasgow Coma Scale ≤8 (aOR 4.86, 95% CI 2.05-11.50), bilateral non-reactive pupils (aOR 4.10, 95% CI 1.13-14.86), age per 10-year increase (aOR 1.42, 95% CI 1.13-1.79), preoperative hypotension (aOR 2.79, 95% CI 1.01-7.71), midline shift >10 mm (aOR 2.53, 95% CI 1.07-5.98), and compressed or absent basal cisterns (aOR 2.71, 95% CI 1.12-6.57). The model showed apparent good discrimination with an in-sample AUC of 0.86.Conclusion
Greater neurological injury severity, bilateral nonreactive pupils, preoperative hypotension, increasing age, and CT markers of intracranial mass effect were independently associated with unfavorable three-month neurological outcome among surgically treated patients with traumatic ASDH. These findings may assist postoperative risk stratification but should not be interpreted as evidence of the effectiveness or appropriateness of surgical evacuation.
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BibTeX
@article{shahid2026predictors,
title = {{Predictors of Postoperative Neurological Outcome After Surgical Evacuation of Traumatic Acute Subdural Hematoma: A Retrospective Cohort Study}},
author = {Muhammad Nauman Shahid and Zainab Wasim Sulehri and Mah Noor Shafiq and Hamna Abdul Ghaffar and Mohsin Tahir and Noman Ahmad and Ayesha Khalid and Ali Khalid and Nadia Ishtiaq},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.117172},
url = {https://europepmc.org/article/PMC/PMC13718879},
note = {CC BY},
}
RIS
TY - JOUR
TI - Predictors of Postoperative Neurological Outcome After Surgical Evacuation of Traumatic Acute Subdural Hematoma: A Retrospective Cohort Study
AU - Muhammad Nauman Shahid
AU - Zainab Wasim Sulehri
AU - Mah Noor Shafiq
AU - Hamna Abdul Ghaffar
AU - Mohsin Tahir
AU - Noman Ahmad
AU - Ayesha Khalid
AU - Ali Khalid
AU - Nadia Ishtiaq
PY - 2026
DA - 2026/09/29
JO - Cureus
DO - 10.7759/cureus.117172
UR - https://europepmc.org/article/PMC/PMC13718879
AB - Background Traumatic acute subdural hematoma (ASDH) is a severe consequence of traumatic brain injury and is associated with substantial mortality and neurological disability among surgically treated patients.Objective To identify clinical, physiological, radiological, and operative factors associated with unfavorable three-month neurological outcome and to support risk stratification among patients undergoing surgical evacuation of traumatic ASDH.Methods This retrospective cohort study included 120 adults who underwent surgical evacuation of traumatic ASDH at Ghurki Trust Teaching Hospital, Lahore, between March 2025 and March 2026. Demographic, clinical, radiological, and perioperative variables were evaluated. The primary outcome was unfavorable neurological status at three months, defined as a Glasgow Outcome Scale-Extended (GOSE) score of 1-4. Multivariable logistic regression was used to identify factors independently associated with unfavorable outcomes. As all participants underwent surgery and no non-operative comparison group was included, the study was designed to evaluate prognostic associations rather than the effect of surgical evacuation itself.Results The mean age was 50.8 ± 17.9 years; 75 (62.5%) patients were male, and 45 (37.5%) were female. An unfavorable neurological outcome occurred in 74 (61.7%) patients, and three-month mortality was 21.7% (26/120). Factors independently associated with unfavorable outcome were admission Glasgow Coma Scale ≤8 (aOR 4.86, 95% CI 2.05-11.50), bilateral non-reactive pupils (aOR 4.10, 95% CI 1.13-14.86), age per 10-year increase (aOR 1.42, 95% CI 1.13-1.79), preoperative hypotension (aOR 2.79, 95% CI 1.01-7.71), midline shift >10 mm (aOR 2.53, 95% CI 1.07-5.98), and compressed or absent basal cisterns (aOR 2.71, 95% CI 1.12-6.57). The model showed apparent good discrimination with an in-sample AUC of 0.86.Conclusion Greater neurological injury severity, bilateral nonreactive pupils, preoperative hypotension, increasing age, and CT markers of intracranial mass effect were independently associated with unfavorable three-month neurological outcome among surgically treated patients with traumatic ASDH. These findings may assist postoperative risk stratification but should not be interpreted as evidence of the effectiveness or appropriateness of surgical evacuation.
SN - 2168-8184
ER -