Acute Subdural Hematoma with CT Thickness >10 mm or Midline Shift >5 mm

This protocol addresses acute subdural hematoma in patients whose CT imaging reveals a hematoma thickness greater than 10 mm or a midline shift greater than 5 mm. These CT thresholds define a high-acuity subset in which the imaging findings — not the neurological examination alone — drive the management decision.

CT Imaging Thresholds

Either finding independently triggers this pathway: clot thickness exceeding 10 mm on CT, or midline shift exceeding 5 mm. Crucially, these thresholds apply regardless of the patient's Glasgow Coma Scale (GCS) score at presentation — a GCS within normal limits does not alter the indication.

Treatment Approach

The management framework centres on a surgical intervention directed at hematoma evacuation. Timing of that intervention is a key determinant of outcome — the structured protocol specifies the urgency requirements and the full decision algorithm.