Acute Post-Traumatic Subdural Haematoma in a Resource-Limited Setting: Presentation, Management and Prognostic Factors for Unfavourable Outcome

Background. Acute subdural haematoma (ASDH) is one of the deadliest focal lesions after traumatic brain injury (TBI). Where CT, intracranial-pressure monitoring and operating theatres are hard to access, little is known about its prognosis.Objective. To describe the presentation and management of ASDH as the principal lesion and to look for factors associated with unfavourable outcome.Methods. Retrospective single-centre study using the TBI database of Bouaké University Hospital (Côte d’Ivoire), historical (2016–2021) and recent (2025–2026) series. We included patients whose principal lesion was ASDH (n = 149). Outcome was unfavourable when the Glasgow Outcome Scale (GOS) was ≤ 3 at last documented contact, deaths included. After univariable comparisons (Mann–Whitney, Fisher’s exact test), we fitted Firth penalised logistic regression restricted to two variables, because events were few.Results. Median age was 35 years, 85.9% of patients were male and median admission GCS was 13. A procedure was entered in the operating register for 66.4%; in-hospital mortality was 6.7%. Of 138 patients with evaluable outcome, 12 (8.7%) had an unfavourable outcome. Low GCS, anisocoria, intubation and severe TBI were associated with it (all p ≤ 0.003); age and time to admission were not. GCS remained strongly associated with unfavourable outcome after adjustment for age (OR 0.58 per point; 95% CI 0.42–0.74).Conclusion. On admission, GCS was strongly associated with unfavourable outcome, independently of age. With 12 events the analysis is exploratory: it could not adjust for anisocoria or for surgery.