Incidence of surgically treated chronic subdural hematoma after head injury with normal initial computed tomography

• Published in: Acta neurochirurgica 2024-03, Vol.166 (1), p.144-144, Article 144
• Main Authors: Heinonen, Aaro, Rauhala, Minna, Isokuortti, Harri, Raj, Rahul, Kataja, Anneli, Nikula, Milaja, Öhman, Juha, Iverson, Grant L., Luoto, Teemu
• Format: Article
• Language: English
• Subjects: Blood; Brain; Brain trauma; Computed tomography; Dura mater; Emergency medical care; Head; Head injuries; Hematoma; Interventional Radiology; Medical records; Medicine; Medicine & Public Health; Meninges; Minimally Invasive Surgery; Neuroimaging; Neurology; Neuroradiology; Neurosurgery; Original Article; Patients; Surgical Orthopedics; Tomography; Trauma; Traumatic brain injury
• ISSN: 0942-0940; 0001-6268; 0942-0940
• DOI: 10.1007/s00701-024-06040-y

Purpose The objective was to determine the incidence of surgically treated chronic subdural hematoma (cSDH) within six months after head trauma in a consecutive series of head injury patients with a normal initial computed tomography (CT). Methods A total of 1941 adult patients with head injuries who underwent head CT within 48 h after injury and were treated at the Tampere University Hospital’s emergency department were retrospectively evaluated from medical records (median age = 59 years, IQR = 39–79 years, males = 58%, patients using antithrombotic medication = 26%). Patients with no signs of acute traumatic intracranial pathology or any type of subdural collection on initial head CT were regarded as CT negative ( n  = 1573, 81%). Results Two ( n  = 2) of the 1573 CT negative  patients received surgical treatment for cSDH. Consequently, the incidence of surgically treated cSDH after a normal initial head CT during a six-month follow-up was 0.13%. Both patients sustained mild traumatic brain injuries initially. One of the two patients was on antithrombotic medication (warfarin) at the time of trauma, hence incidence of surgically treated cSDH among patients with antithrombotic medication in CT negative patients ( n  = 376, 23.9%) was 0.27%. Additionally, within CT negative  patients, one subdural hygroma was operated shortly after trauma. Conclusion The extremely low incidence of surgically treated cSDH after a normal initial head CT, even in patients on antithrombotic medication, supports the notion that routine follow-up imaging after an initial normal head CT is not indicated to exclude the development of cSDH. Additionally, our findings support the concept of cSDH not being a purely head trauma-related disease.