A Prospective Study to Compare the Outcome of Early Surgical and Conservative Line of Management in Patients of Traumatic Intracerebral Hematomas
Introduction and Objective: Traumatic brain injuries (TBIs) are a leading cause of morbidity, mortality, disability, and socioeconomic losses in India and other developing countries. It is a global health epidemicthat has deleterious consequences for the individuals with the brain injury, their families, and the society. The development and validation of effective treatments are imperative. The present study aims to compare the outcomes of early surgical intervention and conservative line of management in traumatic ICH patients. Materials and Methods: The present study was carried out on patients admitted in surgical wards as a case of head injury due to road traffic accidents, assaults, and falls who attended Casualty Department or Surgery/Neurosurgery Outpatient Department, Sanjay Gandhi Memorial Hospital during June 1st, 2016 to May 31st, 2017. Patients who presented within 24 h of TBI and had evidence of a traumatic ICH on CT with a confluent volume of 20 mL or more were included in the study. Only traumatic ICH patients for whom the treating neurosurgeon was in equipoise about the benefits of early surgical evacuation, compared with initial conservative treatment, were eligible for the study. Result: 63.15% of severe head injury patients who underwent early surgical evacuation of hematoma died and 36.85% had a poor outcome as compared to 80% of severe head injury patients under conservative management group died and 20% had a poor outcome. 62.5% of moderate head injury patients who underwent early surgical evacuation of hematoma had a good outcome where as only 45.45% of moderate head injury patients who were managed conservatively had good outcome. Also mortality of moderate head injury patients was higher in conservatively treated group where 36.37% patients died where as only 18.75% of patients died in early surgical evacuation group. 100% of patients of mild head injury under early surgical evacuation of hematoma group had a good outcome as compared to 96.00% of mild head injury patients of conservative management group had a good outcome and 4.00% had a poor outcome. Conclusion: There is a strong evidence in favor of early surgical evacuation of hematoma in patients with traumatic intracerebral hemorrhage who have a GCS of 9–12. Those who have mild head injury (GCS 13–15) can probably be watched carefully for any deterioration because there is a safety margin, which diminishes as the GCS of the patient descends. Once the GCS has descended below 9, surgical intervention appears to be less effective. A larger trial is needed to confirm or refute this evidence, which is particularly strong in patients with a randomization GCS of 9–12.