Do Traumatic Acute Subdural Hematoma Patients with a Glasgow Coma Scale Score of 3 and Bilateral Fixed and Dilated Pupils Have any Chance of Survival?

  • Dr Siva Rama Krishna Valluru Rangaraya Medical College, Kakinada, Andhra Pradesh, India
  • M Premjit Ray RangarayaMedical College, Kakinada, Andhra Pradesh, India
  • Chandu Lingolu Rangaraya MedicalCollege, Kakinada, Andhra Pradesh, India
Keywords: Acute subdural hematoma, Glasgow coma scale, Outcome, Pupil reactivity, Pupil size, Trauma


Background: Low Glasgow coma scale score (GCS) and pupillary status predict poor outcomes in traumatic acute subdural hematoma (ASDH) patients. We compared the mortality of GCS 3 patients having bilateral fixed and dilated pupils (BFDPs) with GCS 3 patients having reactive pupils (RPs). We then determined if trauma system or patient factors were responsible for the difference in mortality. Methods: We reviewed all adult, traumatic ASDH patients with GCS 3, admitted to our institution from December 1, 2015 to December 31, 2017. Demographics, injury data, prehospital times, procedures, and outcomes were recorded. Results: During this period, 145 patients were admitted with GCS of 3, and met inclusion criteria. In all, 100 patients were analyzed, after excluding 20 patients who were dead on arrival, and 25 others, who were intoxicated with alcohol or received paralytic agents in the trauma room. All BFDP patients died, whereas 87% of RP patients died. With regard to patient factors, BFDP patients were more likely to be unstable, have extra-axial bleeding, and evidence of midline shift and/or herniation. Trauma system factors, however, may also have had an impact on outcome. Despite having more extra-axial bleeding, BFDP patients were less likely to have a neurosurgical operation than RP patients. Conclusion: Patients with GCS of 3 and BFDPs have a 100% mortality. These patients have suffered devastating brain injuries and tend to be hemodynamically unstable. Clinicians, however, are less likely to aggressively treat BFDP patients than RP patients. Further prospective studies are required to determine which patients with GCS of 3, and BFDPs are likely to benefit from aggressive treatment.

Author Biographies

Dr Siva Rama Krishna Valluru, Rangaraya Medical College, Kakinada, Andhra Pradesh, India

Post Graduate of Neurosurgery and Assistant Proffessor of Surgery, Department of

M Premjit Ray, RangarayaMedical College, Kakinada, Andhra Pradesh, India

Ray, Proffessor of Neurosurgery, Department of Neurosurgery

Chandu Lingolu, Rangaraya MedicalCollege, Kakinada, Andhra Pradesh, India

Senior Resident, Department of Neurosurgery