Acute Traumatic Subdural Hematomas - When (and why) do we stop? The atSDH-stop survey

Objective: This study investigates the decision-making process among neurosurgeons regarding the surgical management of Acute Subdural Hematomas (ASDH), focusing on the role of non-classical Brain Trauma Foundation (BTF) factors such as brainstem reflexes, hypocoagulation, and patient comorbidity, alongside traditional guidelines. Methods: We conducted an international survey that presented neurosurgeons with real-case scenarios, designed to assess the impact of both traditional and non-traditional prognostic indicators on their surgical decisions. The survey also collected demographic data to examine potential correlations with decision-making preferences. Results: The survey garnered 67 responses from neurosurgeons across 22 countries, revealing a reliance on non-classical BTF factors in decision-making for ASDH cases with a potentially poor prognosis. No significant correlations were found between these decision-making practices and the surgeons' demographic characteristics. Conclusion: The findings highlight the complexity and nuanced nature of surgical decision-making in ASDH management, underlining the importance of non-traditional prognostic factors. The results advocate for further research to refine clinical guidelines, ensuring they encapsulate the breadth of factors considered in practice, thereby enhancing patient-centered care.

Publication History

Received: 09 November 2024

Accepted: 13 March 2025

Accepted Manuscript online:
18 March 2025