Comparison of Early vs. Late Tracheostomy in Subdural Hematoma Operated at GCS Six or Below
Objectives:To compare the outcomes of early tracheostomy vs. late tracheostomy in post-operative patients after acute subdural hematoma at receiving GCS (Glasgow comma scale) of six or below.
Method: A quasi observational study was conducted on 30 patients with acute subdural hematoma after RTA (road traffic accident) and were operated in The Department of Neurosurgery Unit 2, Punjab Institute of Neurosciences, LGH, Lahore. The age range was 20 – 65 years. All patients were operated upon within 12 hours of RTA.
Results: In Group A, 12 (40%) patients, decompressive craniectomy with the evacuation of acute subdural hematoma and early tracheostomy were performed. In Group B, 8 (26%) patients’ craniotomy and evacuation of acute subdural hematoma were done along with early tracheostomy. In 6(20%) patients, decompressive craniectomy and evacuation were done and their tracheostomies were done at the 10th post-operative day. In 4 (13.33%) patients’ craniotomy and evacuation of hematoma done and their tracheostomies were also done at 10th post-operative day. In Group A, on 5th postoperative day GCS of 16 (53.33%) patients with early tracheostomies and fewer comorbidities improved, they were extubated, while 2 (6.67%) patients did not improve and 2 (6.67%) patients died. In Group B, in 30 patients with late tracheostomies, only 4 (13.33%) patients were improved. On 10th post-op day, GCS of 4 (13.33%) patients improved, GCS of 3 (10%) patients not improved and 3 (10%) patients died.
Conclusion: Early tracheostomy in patients with acute subdural hematoma yields good results as compared to late tracheostomy.
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