Incidence of surgically treated chronic subdural hematoma after head injury with normal initial computed tomography

Aaro Heinonen, Minna Rauhala, Harri Isokuortti, Rahul Raj, Anneli Kataja, Milaja Nikula, Juha Öhman, Grant L. Iverson, Teemu Luoto

Research output: Contribution to journalArticleScientificpeer-review


Purpose: The objective was to determine the incidence of surgically treated chronic subdural hematoma (cSDH) within six months after head trauma in a consecutive series of head injury patients with a normal initial computed tomography (CT). Methods: A total of 1941 adult patients with head injuries who underwent head CT within 48 h after injury and were treated at the Tampere University Hospital’s emergency department were retrospectively evaluated from medical records (median age = 59 years, IQR = 39–79 years, males = 58%, patients using antithrombotic medication = 26%). Patients with no signs of acute traumatic intracranial pathology or any type of subdural collection on initial head CT were regarded as CT negative (n = 1573, 81%). Results: Two (n = 2) of the 1573 CT negative patients received surgical treatment for cSDH. Consequently, the incidence of surgically treated cSDH after a normal initial head CT during a six-month follow-up was 0.13%. Both patients sustained mild traumatic brain injuries initially. One of the two patients was on antithrombotic medication (warfarin) at the time of trauma, hence incidence of surgically treated cSDH among patients with antithrombotic medication in CT negative patients (n = 376, 23.9%) was 0.27%. Additionally, within CT negative patients, one subdural hygroma was operated shortly after trauma. Conclusion: The extremely low incidence of surgically treated cSDH after a normal initial head CT, even in patients on antithrombotic medication, supports the notion that routine follow-up imaging after an initial normal head CT is not indicated to exclude the development of cSDH. Additionally, our findings support the concept of cSDH not being a purely head trauma-related disease.

Original languageEnglish
Article number144
JournalActa Neurochirurgica
Issue number1
Number of pages8
Publication statusPublished - 2024
MoE publication typeA1 Journal article-refereed

Bibliographical note

Publisher Copyright:
© The Author(s) 2024.

Fields of Science

  • Chronic subdural hematoma
  • Computed tomography
  • CT negative
  • Head injury
  • 3124 Neurology and psychiatry
  • 3126 Surgery, anesthesiology, intensive care, radiology

Cite this