Factors influencing the outcome of patients with acute extradural haematomas undergoing surgery

Abstract

Background: Acute extradural haematoma (EDH) remains most common cause of mortality and disability resulting from traumatic brain injury. In the last three decades, improvements in rescue, neuromonitoring, diagnostic procedure and intensive care have led to better outcomes. The purpose of this study was to evaluate the factors influencing the outcome in patients with EDH undergoing surgery treated in a tertiary hospital in Bangladesh. Methods: In this retrospective study, 102 consecutive patients with acute EDH who underwent craniotomy were included. The study was carried out from July 2003 to December 2005. The diagnosis was made clinically and radiologically by CT scan. Patients were grouped on the basis of Glasgow Coma Scale (GCS) and operative outcomes were evaluated by Glasgow Outcome Scale (GOS) Results: More than half sampled respondents' (57%) age were more than 20 years while rests of the patients below 20 years with male predominance (Male: Female -12:1). About 7 in 10 respondents (70.6%) were working. Similarly, majority of the respondents (79.4%) had lost more than 30 ml blood. A notable proportion of the respondents (73.5%) had good GCS score (9-15 score) during admission. Similarly majority of the respondents (70.6%) had GCS score 9-15 and 29.4% had GCS score 3-8 before surgery. Road Traffic Accident (RTA) (65%) is the most common cause of EDH followed by assault (20%) and fall from height (12%). Temporal and temporo-parietal locations were the most common site of EDH (56%). Patients with good GCS before surgery had significantly better outcome (89%) compare to those who had bad GCS (10%). Conclusion: Level of consciousness before surgery is the most important factor affecting the outcome. Hence, early diagnosis and surgical intervention is very essential.

Emergency Craniotomy and Burr-Hole Trephination in a Low-Resource Setting: Capacity Building at a Regional Hospital in Cambodia

“…All acute EDH patients in our cohort underwent craniotomy except one patient who underwent burr-hole trephination. The surgical management in our study was similar to the published studies, which mainly involved craniotomy [ 24 , 26 , 27 , 28 ]. We observed mortality of 7%, which was slightly higher than the 2% across England and Wales [ 27 ] and the 3.3% in Hong Kong [ 24 ].…”

Outcome of traumatic Extradural Hematoma (EDH) using Glasgow Outcome Scale (GOS)

“…Road traffic accidents were the commonest (82.4%) cause of extradural hematoma in all the studies. However, the relative proportions of RTA as mode of trauma is quite high (82.4%) in present study compared to other studies where the relative proportions range from 56% Phoebe et al to 65% Islam et al 6,7 The incidence of assaults was relatively less common in present study as compared with various studies, Rehman et al (21%), Islam et al (20%). Fall accounted for a smaller number of cases in most studies including the present study except in study by Phoebe et al in which it constituted for about 30% of cases (Table 2).…”

Outcome of Traumatic Subarachnoid Hemorrhage in Patients Presenting to Neurosurgery Department Lady Reading Hospital Peshawar

“…In population having age less than 45 years' head injury is considered in one of the leading causes of morbidity and mortality. Head injury is responsible for 70% deaths in trauma patients and furthermore those who remain alive after trauma the permanent disabilities are mostly due to the head injuries 1 .…”

“…Head injury is responsible for 70% deaths in trauma patients and furthermore those who remain alive after trauma the permanent disabilities are mostly due to the head injuries. 1 Approximately 100 billion dollars are spent every year on patients of head injuries in United States . 2 When a person sustains head injury the protocols of both basic and advanced life support are applied even at the site of the scene by prehospital person and it has a positive effect on the outcome of patients.…”