Acute Surgery vs Conservative Treatment for Traumatic Acute Subdural Hematoma

Among US trauma centers, is a treatment strategy for traumatic acute subdural hematoma (ASDH) preferring acute surgery superior to one preferring conservative treatment?In this comparative effectiveness study of 711 patients with ASDH across 18 trauma centers, treatment varied highly between centers; proportions of patients undergoing acute surgery ranged from 0% to 86% (median, 17% [IQR, 5%-27%]). Center preference for acute surgery over conservative treatment was not associated with better 6-month outcomes.This study suggests that patients with ASDH treated in centers that prefer acute surgery over conservative treatment have outcomes similar to patients treated in centers that prefer conservative treatment over acute surgery.

Corresponding Author: Thomas A. Van Essen, MD, PhD, Leiden University Medical Center, Leiden, Albinusdreef 2, 2333 ZA Leiden, The Netherlands (essen@lumc.nl).

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