Subdural Haematoma at the Royal Darwin Hospital, Australia: A 6-Year Review of Epidemiology, Management and Outcomes.

Abstract

Background: Subdural haematoma (SDH) is an increasingly common neurosurgical condition, particularly in aging and at-risk populations. In the Northern Territory, the burden of neurotrauma is compounded by geographic remoteness and disparities in access to care. This study aimed to describe the incidence, management and outcomes of SDH at Royal Darwin Hospital.

Methods: A retrospective cohort study was conducted of all adults (≥ 18 years) admitted to Royal Darwin Hospital with convexity SDH between June 2014 and May 2020. Clinical and radiological data were extracted from medical records. Incidence was calculated using 2016 Census data. Outcomes were assessed using the Glasgow Outcome Scale-Extended (GOSE) at discharge and 6 months.

Results: A total of 247 patients were included. The incidence of SDH was 23.4 per 100 000 person-years (95% CI: 17.3-31.7), higher than national estimates. Patients travelled a mean distance of 121 km to access care, highlighting geographic barriers. Most patients (67%) presented with acute SDH, and 44% underwent surgical intervention, with burrhole drainage being the most common procedure. Functional outcomes were favourable in 65.2% at discharge and 70.5% at 6 months. Initial Glasgow Coma Scale scores strongly predicted outcomes. The 30-day mortality rate was 16.9%.

Conclusion: SDH represents a significant burden on regional neurosurgical services in Northern Australia. The findings underscore the challenges of delivering timely care across vast distances and the need for improved service models to support neurotrauma care in rural and remote settings.