Abstract
Introduction: Traumatic subdural hematoma (SDH) and epidural hematoma (EDH) are major extra-axial hemorrhages requiring prompt detection. Non-contrast computed tomography (NCCT) is the primary imaging modality, and hematoma thickness and midline shift are key measures of mass effect. This study assessed the distribution and CT characteristics of traumatic SDH, EDH, and combined SDH/EDH in adults with head trauma.
Methods: This prospective observational study was conducted in the Department of Radiodiagnosis and Medical Imaging at a tertiary care center in Nepal from November 2025 to May 2026. Adult patients aged ≥18 years with traumatic SDH, EDH, or combined SDH/EDH on NCCT were consecutively enrolled. Hematoma category, maximum hematoma thickness, and midline shift were recorded. Data were analyzed using PSPP 2.1.1. The Kruskal–Wallis test, chi-square test, and Spearman's rank correlation were used, with p < 0.05 considered significant.
Results: A total of 150 patients were included (mean age, 50.81 ± 17.92 years; 74.00% male). SDH was the most frequent category, followed by EDH and combined SDH/EDH. EDH had the greatest mean maximum thickness, and the difference among categories was significant (H = 18.43, p < 0.001). Midline shift occurred in 45 (30.00%) patients and did not differ significantly across categories (p = 0.13). No significant correlation was found between maximum hematoma thickness and midline-shift magnitude (ρ = 0.02, p = 0.88).
Conclusions: SDH was the predominant extra-axial hematoma, while EDH had the greatest thickness. Thickness and midline shift appear to provide complementary rather than interchangeable information. NCCT remains essential for characterizing these lesions.
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Copyright (c) 2026 Rajendra K.C., Subash Chandra Yadav, Sanju Rawal, Bardan Oli, Krishna Thapa, Mukhi Sadhan