Pavel Pichardo-RojasFrancisco A. Rodriguez-ElvirAmir Hjeala‐VarasRoberto Sanchez‐VelezEmma Portugal-BeltránAldo Barrón‐LomelíPriscilla Isabel FreemanAntonio DonoRyan S. KitagawaYoshua Esquenazi2026-03-222026-03-22202410.1227/neu.0000000000003200https://doi.org/10.1227/neu.0000000000003200https://andeanlibrary.org/handle/123456789/75818Patients with ASDH undergoing DC across unmatched cohorts had a worse GCS at admission. Although ASDH mortality was lower in the CO group, these findings are derived from unmatched cohorts, potentially confounding previous analyses. Notably, population-matched studies, such as the RESCUE-ASDH trial and PSM cohorts, showed similar effectiveness in mortality and functional outcomes between CO and DC. Reoperation and complication rates were comparable among surgical approaches. Considering the prevalence of unmatched cohorts, our findings highlight the need of future clinical trials to validate the findings of the RESCUE-ASDH trial.enMedicineGlasgow Coma ScaleDecompressive craniectomyGlasgow Outcome ScaleCraniotomyTraumatic brain injuryAcute subdural hematomaPropensity score matchingSurgeryConfoundingarticle