Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Consider referring a patient with a subdural haematoma for neurosurgical evaluation if any of the following are present:
- New and surgically significant abnormalities on imaging, as defined by local neurosurgical centres and agreed referral procedures.
- Persisting coma with a Glasgow Coma Scale (GCS) score of 8 or less after initial resuscitation.
- Unexplained confusion that persists for more than 4 hours.
- Deterioration in GCS score after admission, especially worsening motor response.
- Progressive focal neurological signs.
- A seizure without full recovery.
- A definite or suspected penetrating head injury.
- A cerebrospinal fluid leak.
These criteria indicate the need to discuss the patient's care plan with a neurosurgeon urgently to determine the need for transfer or intervention.