Immediate prognostic outcome in traumatic epidural hematoma at a tertiary care centre

Background: Traumatic brain injury (TBI) is one of the leading causes of death and disability. It is a critical issue in dealing with public health and socioeconomic crisis throughout the world. Extradural hematomas (EDH) accounts for 10.6% of all head injury patients admitted to the hospital and occur in 5-15% of fatal head injuries. This was a single center, retrospective, multivariate analysis of 1150 patients with EDH treated at a tertiary care hospital in India. Objective(S): To assess the immediate and long term outcome of patients in terms of the Glasgow outcome score (GOS), and to analyze the factors predicting outcome in patients managed for traumatic EDH. Methods: Retrospective single center study. Details of patients who were admitted with traumatic EDH from August 2013 to July 2016 were collected from medical records and discharge summaries, namely, patient’s age, sex, mode of injury, Glasgow coma scale (GCS), nature of pupils at admission, head CT at the time of admission including volume of EDH, associated lesions, midline shift and degree of effacement of basal cistern, management and duration of hospital stay. Results: 1015 patients were males (88.1%) and 137 patients were females (11.9%). Median age at presentation was 30 years (22-43 years). The most common mode of injury was road traffic accident which accounted for 87.8%. The most common presenting complaint was head ache (61.8%) followed by loss of consciousness (31.4%). There exists a significant negative correlation (spearman correlation coefficient - -0.171; p - 0.000) between age and GCS at admission. significant relationship exists between GCS at admission and age, sex of the patient, volume of EDH, pupils at admission, cisternal effacement and midline shift (p - <0.05). 387 had associated intracranial lesions. 64.5% had associated fractures, of which temporal bone fractures were the most common (33.2%) followed by frontal bone fractures (19.5%). Among those patients who survived (966 patients (83.85%)), mean duration of stay was 8 days (6-12 days). Surgery was indicated for 402 patients (34.9%) Conclusions: Factors for good functional outcome of treatment of EDH as noted in this study are abnormal pupils on admission, GCS at admission, presence of associated intracranial lesions and time between neurological deterioration and surgery. Other prognostic factors identified from our study includes age of the patient, sex, volume of EDH >30ml, cisternal effacement and midline shift >5mm.