Most of the studies that examined the prognosis of acute subdural hematoma (ASDH) in severe head injury patients stated their overall prognosis as one group. The aim of the present study was to assess the prognosis of ASDH of > 10 mm in thickness in head injury patients with an extension or no motor response to pain after resuscitation. This retrospective study reviewed the severe head injury patients admitted to our university hospitals from January 2014 to August 2017. The inclusion criteria were the patients with an extension or no motor response to pain after resuscitation with an ASDH > 10 mm in thickness and a midline shift > 5 mm in the initial head computed tomography (CT) scan. Two hundred six patients met the inclusion criteria of this study. Their mean age was 42.3 years. One hundred forty-two patients (68.9%) were males. The mean duration between trauma and admission was 41 min. Sixty-two patients (30%), including 38 anonymous patients, were surgically managed and the remainder were managed conservatively. All patients (100%) died in the intensive care unit within 1 month after trauma. This study emphasized that both surgical and conservative management of ASDH had similar dismal results and that there was no additional benefit from surgical intervention in the studied group of head injury patients. Randomized controlled trials are needed to set a standard of care for the management of ASDH in this subgroup of the severe head injury patients.

中文翻译：

---

颅脑损伤硬膜下血肿厚度大于10mm的患者在复苏后对疼痛的扩展或无运动反应的预后

大多数检查严重颅脑损伤患者急性硬脑膜下血肿（ASDH）预后的研究都将其整体预后视为一组。本研究的目的是评估复苏后扩展或对疼痛无运动反应的颅脑损伤患者ASDH厚度> 10 mm的预后。这项回顾性研究回顾了2014年1月至2017年8月入读我们大学医院的严重颅脑损伤患者。纳入标准为复苏后ASDH厚度> 10 mm且中线移位的患者对疼痛的延伸或无运动反应最初的头部计算机断层扫描（CT）扫描中> 5 mm。266名患者符合本研究的纳入标准。他们的平均年龄是42.3岁。一百四十二名患者（68.9％）是男性。创伤与入院之间的平均持续时间为41分钟。手术治疗了62例患者（占30％），其中包括38例匿名患者，其余患者则进行了保守治疗。所有患者（100％）在创伤后1个月内在重症监护病房死亡。这项研究强调，ASDH的外科手术治疗和保守治疗均具有相似的令人沮丧的结果，并且在研究组的颅脑损伤患者中，手术干预并没有额外的好处。需要随机对照试验来为重度颅脑损伤患者这一亚组中的ASDH的治疗制定标准。所有患者（100％）在创伤后1个月内在重症监护病房死亡。这项研究强调，ASDH的外科手术治疗和保守治疗均具有相似的令人沮丧的结果，并且在研究组的颅脑损伤患者中，手术干预并没有额外的好处。需要随机对照试验来为重度颅脑损伤患者这一亚组中的ASDH的治疗制定标准。所有患者（100％）在创伤后1个月内在重症监护病房死亡。这项研究强调，ASDH的外科手术治疗和保守治疗均具有相似的令人沮丧的结果，并且在研究组的颅脑损伤患者中，手术干预并没有额外的好处。需要随机对照试验来为重度颅脑损伤患者这一亚组中的ASDH的治疗制定标准。