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Case report
Traumatic subdural haematoma: integrating case-based clinical judgement with guidelines
  1. Aditya Samitinjay1,
  2. Satya Revanth Karri2,
  3. Praveen Khairkar2 and
  4. Rakesh Biswas1
  1. 1Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India
  2. 2Department of Psychiatry, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India
  1. Correspondence to Professor Rakesh Biswas; rakesh7biswas{at}


Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity with a significant loss of functional capacity and a huge socioeconomic burden. Road traffic accidents are the most common (60%) cause followed by falls and violence in India and worldwide. This case discusses the story of a 23-year-old man with severe TBI–subdural haematoma, who presented in a comatose state. The patient was a purported candidate for emergency decompressive surgery as per Brain Trauma Foundation (BTF) guidelines but was managed conservatively. This case questions the plausibility of the BTF guidelines for severe TBI, particularly in rural hospitals in India and how such cases are often managed with clinical judgement based on the review of literature. The patient recovered well with a perfect 8/8 on Glasgow Outcome Scale Extended Score.

  • trauma
  • adult intensive care
  • coma and raised intracranial pressure
  • neurosurgery
  • psychiatry

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  • Contributors AS was involved in conception and design, and drafting and final approval of the submitted version. RB was involved in conception and design, drafting and revising the article, and editing and final approval of the submitted version. PK was involved in drafting the article and making a complete neuropsychiatric evaluation of the patient. SRK was involved in drafting and editing the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.