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All Journal Sriwijaya Journal of Surgery
Trijoso Permono
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Medicine & Pharmacology

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External Validation of the RASH Score in Surgically Managed Acute Subdural Hematoma: A Critical Appraisal of Prognostic Accuracy and Surgical Factors in a Southeast Asian Cohort Irwansyah; Trijoso Permono; Dwiandi Susilo; Erial Bahar
Sriwijaya Journal of Surgery Vol. 8 No. 2 (2025): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v8i2.134

Abstract

Introduction: Acute subdural hematoma (ASDH) is a lethal form of traumatic brain injury (TBI) with high mortality. The Richmond Acute Subdural Hematoma (RASH) score is a simple prognostic tool, but its validity in diverse populations is untested. This study aimed to perform the first external validation of the RASH score in an Indonesian cohort and critically appraise its performance alongside key surgical factors. Methods: We conducted a retrospective, single-center, diagnostic accuracy study of 67 adult patients who underwent surgery for traumatic ASDH between January 2022 and December 2024 at a tertiary neurosurgical center in Palembang, Indonesia. The RASH score was calculated from admission data. We additionally analyzed the type of surgery (craniotomy vs. decompressive craniectomy) and time from injury to operation. The primary outcome was in-hospital mortality. Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the RASH score's predictive performance. Results: The overall in-hospital mortality rate was 20.9% (n=14). The RASH score demonstrated excellent discrimination for mortality, with an Area Under the ROC Curve (AUC) of 0.824 (95% CI: 0.715–0.933; p<0.001). A score of 5 or greater was identified as the optimal cut-off, yielding a sensitivity of 78.6% and specificity of 77.4%. This threshold provided a high Negative Predictive Value (NPV) of 93.2% but a modest Positive Predictive Value (PPV) of 47.8%. In bivariate analysis, decompressive craniectomy and longer time to surgery were significantly associated with mortality. Conclusion: The RASH score is a simple and robust tool for risk stratification in this selected surgical population. Its high NPV is valuable for identifying patients with a higher likelihood of survival. However, its utility must be interpreted cautiously due to the significant selection bias inherent in studying only operable patients. The score should serve as an adjunct to, not a replacement for, comprehensive clinical judgment.
Accuracy of Bleeding Volume as a Predictor of Mortality in Epidural Hemorrhage Patients Undergoing Surgery at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia Stefiyan, Ferdi; Trijoso Permono; Erial Bahar
Sriwijaya Journal of Surgery Vol. 6 No. 2 (2023): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v6i2.93

Abstract

Introduction: EDH is a collection of blood clots between the dura layer and the cranium. This is usually caused by rupture of the middle meningeal artery but can also be caused by rupture of the dural venous sinus, diploic vein, meningeal vein, or bleeding from the fracture line. CT scan is the investigation of choice to detect intracranial injury after trauma. CT scans can also identify additional features that influence the results, namely, midline shifting, blood clot thickness and hematoma volume, cerebral edema, and cranium fractures. This study aimed to determine the accuracy of bleeding volume as a predictor of mortality in epidural hemorrhage patients undergoing surgery at Dr. Mohammad Hoesin General Hospital, Palembang Indonesia. Methods: This study is a retrospective study of prognostic tests to determine the accuracy of bleeding volume as a predictor of mortality in patients with EDH who underwent surgery at Dr. Mohammad Hoesin General Hospital. This study uses secondary data obtained from medical record data at the medical records installation of Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. A total of 106 research subjects participated in this study. Results: The sensitivity value of bleeding volume was 77.7%, and specificity was 78.3%, and also obtained a positive predictive value of 7.21% and a negative predictive value of 97.4%, it can be concluded that bleeding volume is not accurate as a predictor of mortality. Conclusion: Bleeding volume is not an accurate predictor of mortality in epidural hemorrhage patients undergoing surgery at Dr. Mohammad Hoesin General Hospital, Palembang Indonesia.
Mortality Predictors in Spontaneous Intracerebral Hemorrhage: External Validation of the ICH Score in the Indonesian Surgical Population Grady Christian; Trijoso Permono; Ziske Maritska
Sriwijaya Journal of Surgery Vol. 9 No. 1 (2026): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v9i1.143

Abstract

Introduction: Spontaneous intracerebral hemorrhage (ICH) is a major contributor to stroke-related mortality and long-term disability, particularly in Indonesia, which faces the highest age-standardized stroke mortality rate in Southeast Asia. This study evaluates the predictive accuracy of the ICH Score for 30-day mortality among patients undergoing surgical intervention at a primary referral center in South Sumatra. Methods: This analytical observational study utilized a retrospective cohort design, analyzing 81 patients with spontaneous ICH who underwent surgical evacuation at Dr. Mohammad Hoesin Central General Hospital Palembang between July 2024 and June 2025. Demographic, clinical, and radiological parameters were evaluated. Accuracy was determined using Receiver Operating Characteristic (ROC) curve analysis to establish the Area Under the Curve (AUC), sensitivity, and specificity. Results: The cohort was predominantly male (56.8 percent) and aged under 80 years (86.4 percent). Significant predictors of 30-day mortality included age 80 years or older (p < 0.001, OR 26.84), lower Glasgow Coma Scale (GCS) scores (p = 0.012), and the presence of intraventricular hemorrhage (IVH) (p < 0.001, OR 15.24). ROC analysis demonstrated an AUC of 0.958 (95 percent CI 0.910–1.000). An optimal ICH Score cut-off of 3 or higher yielded a sensitivity of 86.2 percent and a specificity of 100 percent. Conclusion: The ICH Score serves as an exceptionally accurate prognostic tool in the Indonesian surgical population. An admission score of 3 or higher is a definitive predictor of mortality, facilitating risk stratification and informed clinical decision-making.
Co-Authors Dwiandi Susilo Erial Bahar Grady Christian IRWANSYAH Stefiyan, Ferdi Ziske Maritska