Protocol-based postoperative brain scan after drainage of chronic subdural hematoma in a low-resource setting (ProtoScan study).

BACKGROUND

Routine postoperative computed tomography (CT) scan in chronic subdural hematoma (cSDH) management is not supported by literature. Yet, many institutions perform routine postoperative scans for several reasons. The dangers are potential for abuse, healthcare cost, and unnecessary exposure to ionizing radiation.

METHODS

Data were collected prospectively on patients who had surgery for cSDH between January 2021 and December 2023. Number of postoperative CT, complication rate, average length of hospital stay, recurrence rate, and functional outcome were analyzed.

RESULTS

One hundred and six patients had surgery and 6 months follow-up record after surgery. There were 89 males (84%) and 17 females (16%). Of the 11 (10.38%) patients who had postoperative brain CT, three had postoperative scan due to new neurological deficits, four did not improve 48 h after surgery, one had cortical injury, and three had initial improvement but then deteriorated within 1 week. Our data showed recurrence in 7 (6.6%) patients, deep vein thrombosis 2 (1.9%), and wound infection and subdural empyema 1 (0.9%). Duration of hospital admission significantly affected complication; 5.9% in patients who stayed <7 days on admission against 18.4% in those who stayed more than 7 days (P = 0.05). Outcome at 6 months revealed that 100 (94.3%) patients had good outcome while 6 (5.7%) had bad outcome.

CONCLUSION

Routine brain CT scan after uncomplicated drainage of cSDH in patients without new neurological symptoms adds no value. A rational clinical approach based on neurologic evaluation should guide the decision on a postoperative scan.