Traumatic Acute Epidural Hematoma: Unrecognized High Lethality in Comatose Patients

Abstract

A series of 51 comatose patients suffering traumatic epidural hematoma after closed head injury is reviewed. This prospective series was accumulated from the National Pilot Traumatic Coma Data Bank during a 2-year period and represents 9% of all patients entered into the Data Bank. The overall mortality was 41%, with 4% remaining in the vegetative state. Fifty per cent of these patients, all of whom were in coma, also had an associated intracerebral contusion. There was no difference in outcome with regard to sex, mode of injury, or the presence or absence of contusion or shift on the computed tomographic (CT) scan. The motor score immediately before operation was the most powerful preoperative predictor of outcome. Sixty-seven per cent or two-thirds of the patients with a motor score of 4, 5, or 6 on the Glasgow coma scale had a satisfactory outcome at last follow-up examination. In contrast, in patients with a motor score of 3 or less, two-thirds either died or remained in a vegetative state. The acute traumatic epidural hematoma is often lethal in the comatose patient. We recommend early evacuation of epidural hematomas, i.e., when they are first noted on the CT scan, rather than waiting for clinical motor deterioration.

Traumatic Extradural Hematoma – Our Comparative Experience between Conservative and Surgical Management in Rural India

“…So it was recommended to immediate evacuation of EDH i.e. when they are first noted on the CT scan rather than waiting for clinical motor deterioration [6]. Until 1980, only a few delayed EDH were recorded, when angiography was used to make the diagnosis.…”

Traumatic Acute Giant Epidural Hematoma in a Hydrocephalic Shunted Child

“…The mortality rate due to EDH is directly related to the level of consciousness at the time of surgery. The operative mortality in an awake, neurologically intact patient tends toward zero regardless of hematoma size or location, but the figure increases dramatically to approximately 40% if the patient is allowed to lapse into coma [4, 5, 6, 7, 8]. …”

Prognostic factors in severely head injured adult patients with epidural haematoma's

“…Patients with direct onset of coma may present associated signs of diffuse axonal injury [32,35] due to high speed trauma's [22] and a significant proportion willl have associated intradural lesions (subdural haematoma, intracerebral posttraumatic damage and hemispheric swelling). The clinical course in these cases is variable and the outcome in most cases related to primary and secondary brain damage [15].…”

“…In two reports no significant relationship between age and outcome was found [19,35]. Epidural haematoma's are uncommon in elderly patients [10] because of the strong adherence of the dura to the inner skull, Published casistics seldom contain more than 10% of patients aged over 50 years [1,7,8,23] and the lack of statistical significance of the association between age and outcome for evacuated epidural haematoma's is probably due to the small number of elderly patients [23].…”

“…Cause of trauma, A poor correlation was found between trauma aetiology and outcome [ t9, 35,38], Fa~ls as a mechanism of trauma were related with a worse prognosis [22] but Ibis is due to the influence of age (fall was the first cause of trauma over 60 years). High speed trauma's usually produce an immediate coma and concomitant diffuse axonal injury [31].…”