CORRELATION BETWEEN PREOPERATIVE GCS SCORE AND POSTOPERATIVE OUTCOME IN TRAUMATIC ACUTE SUBDURAL HAEMATOMA

Khan M. S. I.*, Sarker A. C., Das S., Hossain M. N., Chowdhury F. H., Mukherjee S. K., Alam S., Khan U. K. S., Morshed M. H., Haque S., Rashid M. M. and Begum T.

ABSTRACT

Background: Acute subdural hematomas (ASDH) are observed in one third of patients with severe traumatic brain injury leading to high mortality. Objective: To observe correlation among preoperative and postoperative findings specific to each and every GCS Score. Methods: This prospective interventional study was carried out in the Department of Neuro-Surgery, Dhaka Medical College & Hospital, Dhaka during the period between March 2017 and February 2018. A total of 60 patients irrespective of age and sex with Acute Subdural Haematoma were included in this study. After thorough neurological examination and counseling finally preparared for surgical procedures. Before discharge of the patients, the final neurological examinations were performed and all were advised for scheduled follow up. Results: The mean age was 41.98±20.24 years and male to female ratio was 2.5:1. Regarding, the preoperative GCS it was observed that 38.3% patients showed GCS on admission 9-12 followed by 36.7% on admission 6-8. About post-operative GCS, almost half (46.7%) patients belonged to post-operative GCS (on 1st POD) 6-8. Mean post-operative GCS (on 1st POD) was 7.30±2.88. The postoperative GCS score were observed as 3-15 among the patients. The functional survival in 53.3% cases and the overall mortality rate was 41.7%. The positive significant correlation was found (r=0.704; p=0.001) between admission GCS Score and GCS Score on 1st POD, 3rd POD, 10th POD and GCS Score on 1 month following surgery.. The overall mortality rate and functional survival were 41.7% and 53.3% respectively. Conclusion: Preoperative GCS score and the thickness of the Traumatic Acute Subdural Haematoma are important predictors of mortality. There were statistically positive significant correlation between preoperative GCS Score and postoperative outcome in Traumatic Acute Subdural Haematoma. GCS Score and preoperative CT-Head are important parameters that correlate with the mortality rate.

Keywords: Acute subdural hematomas, traumatic brain injury, motor score, GCS score, decompressive craniectomy, GOS.