Prognosis of patients with bilateral fixed dilated pupils secondary to traumatic extradural or subdural haematoma who undergo surgery: a systematic review and meta-analysis

Scotter, John; Hendrickson, Susan A.; Marcus, Hani J.; Wilson, Mark

doi:10.1136/emermed-2014-204260

Cited by 29 publications

(16 citation statements)

References 25 publications

(16 reference statements)

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“…It is a well-established fact that AEDH is more likely to occur in isolation, while ASDH is more likely to be associated with brain parenchyma injury. It is the associated injuries in ASDH that account for the worse prognosis that is documented almost universally [24,25,28]. This assertion is supported by the finding of our study that the difference in average post resuscitation GCS of the two hematoma (12 vs. 10 for AEDH and ASDH, respectively) was statistically significant (p < 0.01).…”

Section: Short-term Treatment Outcome For Intracranial Extra-axial Hesupporting

confidence: 82%

Thirty-day clinical outcome of traumatic brain injury patients with acute extradural and subdural hematoma: a cohort study at Mulago National Referral Hospital, Uganda

et al. 2020

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Background: Increasing traumatic brain injury (TBI) has paralleled the need for decompression surgery for acute subdural (ASDH) and acute extradural haematoma (AEDH). Knowledge of key determinants of clinical outcomes of such patients is mandatory to guide treatment protocols. Objective: To determine the 30-day clinical outcomes and predictor variables for patients with extra-axial hematomas at Mulago National Referral Hospital in Uganda. Methods: Prospective observational cohort study of 109 patients with computed tomography (CT) confirmed extraaxial hematomas. Ethical clearance was obtained from the

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Section: Short-term Treatment Outcome For Intracranial Extra-axial Hesupporting

confidence: 82%

Thirty-day clinical outcome of traumatic brain injury patients with acute extradural and subdural hematoma: a cohort study at Mulago National Referral Hospital, Uganda

et al. 2020

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“…4 In a systematic review of studies on traumatic SDHs and EDHs with bilateral fixed and dilated pupils, despite the high mortality and morbidity, better functional recovery could be achieved in addition to higher survival rates by aggressive timely surgical interventions. 5…”

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confidence: 99%

Temporal Delays Along the Neurosurgical Care Continuum for Traumatic Brain Injury Patients at a Tertiary Care Hospital in Kampala, Uganda

et al. 2018

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“…Scotter et al investigated the prognosis of patients with bilateral fixed dilated pupils (BFDPs) secondary to an extra-axial haemorrhage who underwent decompressive surgery and published their findings in 2015 2. They concluded that a low threshold for decompression in patients with BFDP and extradural haemorrhages should be adopted, noting that almost two-thirds of patients with extradural haematomas survived after decompression with over half having a good outcome.…”

Section: Discussionmentioning

confidence: 99%

Cranial burr holes in the emergency department: to drill or not to drill?

et al. 2019

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The practice of trepanning (referred to today as a craniotomy) dates back to the Neolithic period. Reasons for drilling a hole through the skull evolved from releasing evil spirits and curing insanity to practical management of head injuries in ancient Greece and Rome. Today, craniotomy or drilling a burr hole through the skull is very much the purview of the neurosurgeon. Yet one could argue that the procedure itself is more ‘bone surgery’ than ‘brain surgery’. Nevertheless, despite the fact that head injury is a common presentation at district general hospitals and traumatic extra-axial haemorrhages are encountered often, the straightforward skillset required to drill a burr hole as a pretransfer, temporising, life-saving measure is seldom taught and has never gained traction. What we advocate in this article is the adaptation and novel application of an old, tried and tested technique in new hands. The critical pathophysiological turning point of any expanding extra-axial haemorrhage is the inflection point on the volume/Intracranial pressure (ICP) curve beyond which compensation is impossible. The subsequent rising ICP initiates a predictable continuum of clinical signs signalling progressive herniation. There are few emergencies as time-critical as a patient with an isolated, expanding extradural haemorrhage embarking on a trajectory of rostrocaudal deterioration and inevitable death. In many cases, the tragedy is compounded by the knowledge that such a patient probably has a healthy underlying brain, often evidenced by a lucid period after trauma. Our emergency department is attached to a small 300-bed District General Hospital (DGH) on the rural North West coast of Ireland. We are 262 km distant by road from a national neurosciences department that can, at best, be reached in 2 hours and 30 min. Quality improvement review of years of dismal outcomes in patients such as those described earlier with potentially remediable pathology prompted research and development of the skillset we are now able to offer, an old technique in new hands.

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Prognosis of patients with bilateral fixed dilated pupils secondary to traumatic extradural or subdural haematoma who undergo surgery: a systematic review and meta-analysis

Abstract: CRD42013005198.

Cited by 29 publications

References 25 publications

Thirty-day clinical outcome of traumatic brain injury patients with acute extradural and subdural hematoma: a cohort study at Mulago National Referral Hospital, Uganda

Thirty-day clinical outcome of traumatic brain injury patients with acute extradural and subdural hematoma: a cohort study at Mulago National Referral Hospital, Uganda

Temporal Delays Along the Neurosurgical Care Continuum for Traumatic Brain Injury Patients at a Tertiary Care Hospital in Kampala, Uganda

Cranial burr holes in the emergency department: to drill or not to drill?

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