Analysis of Factors Affecting Outcome of Acute Extradural Hematoma—Our Observation in Dhaka Medical College and Hospital

Abstract

Background Extradural hematoma (EDH) is a leading cause of death in young population. Timely intervention gives dramatic recovery but often fatal if not treated in time. The surgical outcome of EDH depends on many variables that strongly affect the prognosis of the disease, which are preoperative Glasgow coma scale (GCS), overlying skull fracture, time interval between injury and surgery, other associated intracranial injuries (like cerebral contusion, subdural hematoma, or intracerebral hematoma), pupillary abnormalities(anisocoria), and hematoma volume. But no correlation was found between surgical outcome of EDH and age, sex, etiology, and site of hematoma. Objective We want to identify the factors affecting the surgical outcome of EDH that will help us in preoperative prioritization of the cases for intervention, adequate resuscitation, and counselling the attendant regarding the outcome. Our ultimate goal was to reduce the mortality and morbidity from this disease. Methods This study was conducted on the patients admitted through neuroemergency and diagnosed as EDH by computed tomography scan of head, in the department of Neurosurgery of Dhaka medical college and hospital from January 1, 2017 to December 31, 2019. This is three-year prospective interventional study where all the patients underwent surgical evacuation of EDH on emergency basis and outcome was measured by Glasgow outcome scale (GOS) after 48 hours of admission and at discharge. Results Outcome was divided into good (GOS 4,5) and poor (GOS 1–3) groups. Pre-operative GCS, overlying skull fracture, time interval between injury and surgery, associated intracranial injuries, anisocoria and hematoma volume were the factors affecting the surgical outcome significantly. Conclusion Good surgical outcome is associated with EDH volume less than 40cc, pre-operative GCS more than 8, absence of anisocoria, overlying skull fracture, no associated intracranial injury and surgery within 12 hours of injury. But age, sex and site of EDH has no definite correlation with outcome.

Impact of Time from Injury to Surgery on Postoperative Functional Recovery in Large Volume Traumatic Extradural Hematomas

“…In regards to the factors that can influence the postoperative functional recovery, the prognostic impact of patients' age, preoperative anisocoria, admission GCS, and hematoma volume have been studied most frequently in previous studies. 12,14,17,20,22,23 In our series, none of these factors was a significant predictor for favorable functional recovery.…”

“…Despite the advances in prehospital and inhospital management for trauma patients, there are still relatively high rates of morbidity and mortality in patients with large volume traumatic EDH. 11,12 In our case series, 50 patients (53.8%) underwent surgical evacuation for their EDH in 6 hours following trauma with a mean time to surgery of 4.210 AE 1.270 hours and 43 patients (46.2%) had operations later than 6 hours with a mean time to surgery of 10.962 AE 3.440 hours. Worth mentioning, that delayed arrival of TBI patients to our emergency department after trauma was behind the delay in surgery.…”

“…Despite the advances in prehospital and inhospital management for trauma patients, there are still relatively high rates of morbidity and mortality in patients with large volume traumatic EDH. 11 12…”

“…Lafta et al 17 reported that better functional recovery (p ¼ 0.001) was found among patients with a shorter time interval between injury and patient reception ( 3 hours). Also, in the series of Das et al, 12 all patients (100%) who were operated within 12 hours of injury achieved good outcome, while 94% in whom surgery was done between 12 and 24 hours achieved good outcome and only 64% of those who were operated beyond 24 hours ended up with good outcome. In contrast to our results, the study of Ayogu et al 2 failed to demonstrate an association between outcome and the time interval from trauma until surgery.…”

“…This study was approved by the local ethical scientific committee of our institution (IRB approval number: 4-2023.NEUS 4-1). Head injury patients of either sex with no age restrictions who presented with GCS score (4)(5)(6)(7)(8)(9)(10)(11)(12)(13) and had acute EDH with volume ! 40 cm 3 on brain CT scan were included in our study.…”