====== Acute subdural hematoma conservative treatment ======

The [[Brain Trauma Foundation]] published [[guideline]]s on the surgical management of traumatic [[subdural hematoma]] (SDH). However, no data exist on the proportion of patients with subdural hematoma SDH that can be selected for [[conservative therapy]] and what is the [[outcome]] of these patients
((Bajsarowicz P, Prakash I, Lamoureux J, Saluja RS, Feyz M, Maleki M, Marcoux J. Nonsurgical acute traumatic subdural hematoma: what is the risk? J Neurosurg. 2015 Nov;123(5):1176-83. doi: 10.3171/2014.10.JNS141728. Epub 2015 May 8. PMID: 25955872.)).
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The conservative management of patients with [[acute subdural hematoma]]s can be a viable alternative in certain cases. 
In a patient with acute subdural hematoma for whom a neurosurgeon sees no clear superiority for acute surgery over conservative treatment, initial conservative treatment might be considered
((van Essen TA, Lingsma HF, Pisică D, Singh RD, Volovici V, den Boogert HF, Younsi A, Peppel LD, Heijenbrok-Kal MH, Ribbers GM, Walchenbach R, Menon DK, Hutchinson P, Depreitere B, Steyerberg EW, Maas AIR, de Ruiter GCW, Peul WC; CENTER-TBI Collaboration Group. Surgery versus conservative treatment for traumatic acute subdural hematoma: a prospective, multicentre, observational, comparative effectiveness study. Lancet Neurol. 2022 Jul;21(7):620-631. doi: 10.1016/S1474-4422(22)00166-1. Epub 2022 May 5. Erratum in: Lancet Neurol. 2022 Jul;21(7):e7. PMID: 35526554.))
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Those patients younger than 65 years old, with small acute subdural hematomas and [[Glasgow Coma Scale]] scores greater than 8, will have the best functional outcomes
((Feliciano CE, De Jesús O. Conservative management outcomes of traumatic acute subdural hematomas. P R Health Sci J. 2008 Sep;27(3):220-3. PMID: 18782966.))
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A smaller degree of [[midline shift]] was tolerated by patients with a GCS score of less than 15: a shift of more than 5 mm on the initial CT scans predicted exhaustion of the cerebral compensatory mechanism within 3 days of injury. In such cases, the GCS score worsened, and surgical evacuation of the SDH became necessary. A total hospital stay of 6 to 7 days may suffice for those who have become fully conscious. Repeat CT studies before discharge should be done and a close follow-up during the first 3 to 4 weeks is advisable
((Wong CW. Criteria for conservative treatment of supratentorial acute subdural hematomas. Acta Neurochir (Wien). 1995;135(1-2):38-43. doi: 10.1007/BF02307412. PMID: 8748790.))
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In conservatively managed patients with minimal symptoms and [[mass effect]] on [[head computed tomography]], increasing [[subdural hematoma]] size did not contribute to worsened in-[[Hospital mortality]] or length of stay. Patients with large aSDHs may undergo an initial course of nonoperative management of symptoms and the degree of mass effect are mild
((Kashkoush AI, Whiting BB, Desai A, Petitt JC, El-Abtah ME, Mcmillan A, Finocchioro R, Hu S, Kelly ML. Clinical Outcomes After Nonoperative Management of Large Acute Traumatic Subdural Hematomas in Older Patients: A Propensity-Scored Retrospective Analysis. Neurosurgery. 2022 Nov 1. doi: 10.1227/neu.0000000000002192. Epub ahead of print. PMID: 36598827.)).

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