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Traumatic acute subdural hematoma is common neurologic condition with high morbidity and mortality rate. This retrospective study had aimed to identify factors effecting unfavorable outcome after craniectomy with removal of blood clot in patients with traumatic acute subdural hematoma in ChumphonKhetUdomsakdi hospital. 263 patients who had preoperative Glasgow coma scale 4-8 and had undergone craniectomy for removal of acute subdural hematoma from January 2008 to December 2015 were included. After craniectomy, the patients were divided into two groups based on their Glasgow outcome scale (GOS) as favorable outcomes (GOS 4-5) and unfavorable outcomes (GOS 1-3) which were followed up 6 months post-operatively. The results showed the overall mortality rate was 39.5%, 51.3% had favorable outcomes but 48.7% had unfavorable outcomes. Multiple logistic regression analysis showed five factors significantly effecting unfavorable outcomes include bilateral absent pupillary light reflexes (ORadj= 15.09, p = 0.001), effacement of basal cisterns (ORadj= 12.72, p =0.020), brain swelling factor ≥ 3 mm. (ORadj= 5.98, p = 0.029), platelets count < 100,000/mm3 (ORadj= 5.90, p = 0.033) and unilateral absent pupillary light reflex (ORadj= 2.67, p = 0.002). In conclusion, unilateral and bilateral abnormal pupillary light reflexes, brain swelling factor ≥ 3 mm., effacement of basal cisterns and platelets count < 100,000/mm3 were the most valuable factors that effecting unfavorable outcomes after craniectomy in traumatic acute subdural hematoma patients.