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J Neurol Surg A Cent Eur Neurosurg 2026; 87(02): 077-084
DOI: 10.1055/a-2558-5681
Original Article

Acute Traumatic Subdural Hematomas—When (and Why) Do We Stop? The aSDH-stop Survey

Authors

  • Lídia Nunes Dias 

    1   Department of Neurosurgery, Hospital Egas Moniz – Unidade Local de Saúde de Lisboa Ocidental, Lisboa, Portugal

  • Paulo Jorge da Silva Nogueira

    2   Área Disciplinar Autónoma de Bioestatística, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
    3   Instituto de Saúde Ambiental, Laboratório Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
    4   Escola Nacional de Saúde Pública, ENSP, Centro de Investigação em Saúde Pública, CISP, Comprehensive Health Research Center, CHRC, Universidade NOVA de Lisboa, Lisboa, Portugal
    5   CIDNUR—Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa Escola Superior de Enfermagem de Lisboa, Avenida Professor Egas Moniz, Lisboa, Portugal

  • João Pedro Oliveira

    1   Department of Neurosurgery, Hospital Egas Moniz – Unidade Local de Saúde de Lisboa Ocidental, Lisboa, Portugal

  • José Cabral

    1   Department of Neurosurgery, Hospital Egas Moniz – Unidade Local de Saúde de Lisboa Ocidental, Lisboa, Portugal

Funding None.
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Abstract

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.

Keywords

subdural hematomas - brain trauma - traumatic brain injury - neurotrauma

Supplementary Material



Publication History

Received: 09 November 2024

Accepted: 13 March 2025

Accepted Manuscript online:
18 March 2025

Article published online:
14 November 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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