MORTALITY AND PROGNOSTIC FACTORS IN PATIENTS OPERATED FOR ACUTE EPIDURAL HEMATOMA
DOI:
https://doi.org/10.55519/JAMC-S4-12780Keywords:
epidural hematoma, operative mortality, prognostic factors.Abstract
Background: Epidural hematoma is one of the most common surgical emergencies encountered in neurosurgery. This study was conducted to determine the mortality and prognostic factors in patients operated for traumatic intracranial epidural hematoma in a resource-constrained setting from a developing country. Methods: This retrospective study was conducted in the Department of Neurosurgery at Ayub Teaching Hospital Abbottabad from 1st January 2019 to 31st Dec 2021. Inclusion and exclusion criteria were created. The medical record of 116 patients admitted and operated on for traumatic extradural hematoma was retrospectively reviewed. Information was recorded using a standardized structured questionnaire. The outcome was measured in terms of the Glasgow coma outcome score. Results: Out of 116 patients, 93 were male and 23 were female.19 (16.4%) patients were in the age range 0-5 years, 42 (36.2%) were in the age range 6-15, 35(31.0%) were in the age range 16-30, 11 (9.5%) were in the age range 31-45 years, 7 (6.0%) were in the age range 46-60 years while only one patient included in this study was above 60 years. Overall mortality was 4.3%. Mortality was higher in females and in those aged less than 5 years (3.4%). 4 out of 16 patients died with GCS less than 8, while none of the patients died when GCS was above 12. Mortality was significantly higher in the presence of associated lesions (4.4% vs. 0%) and anisocoria (2.6% vs.1.7%). Patients who operated within 6 hours of trauma resulted in better outcomes with a mortality rate of 0.0% and functional recovery of 57.8 % while for those who operated after 6 hours, mortality was significantly higher (4.3%) and functional recovery was significantly low (15.5%). Conclusion: Good surgical outcomes can be achieved with early operative intervention if indicated. Female gender, low preoperative GCS score, presence of pupillary dilatation, presence of associated lesions, delayed surgical intervention and age less than 5 years are significant predictors for poor outcomes.References
Atci IB, Yilmaz H, Yaman M, Baran O, Türk O, Solmaz B. Incidence, hospital costs and in-hospital mortality rates of surgically treated patients with traumatic cranial epidural hematoma. Romanian Neurosurg 2018;XXXII (1):110–5.
Taussky P, Widmer HR, Takala J, Fandino J. Outcome after acute traumatic subdural and epidural haematoma in Switzerland: a single-centre experience. Swiss Med Wkly 2008;138(19-20):281–5.
Rosyidi RM, Priyanto B, Fauzi AL, Sutiono AB. Toward zero mortality in acute epidural hematoma: A review in 268 cases problems and challenges in the developing country. Interdiscip Neurosurg 2019;17:12–8.
Barbosa TG, Rodrigues LHDS, Xander PAW, Avelar TM, Costa GHFD, Batista AVDS, et al. Traumatic injury of dural venous sinus as cause of epidural hematoma: importance of recognition and adequate surgical planning. Rev Chil Neurocir 2021;47:40–3.
Yilmazlar S, Kocaeli H, Dogan S, Abas F, Aksoy K, Korfali, et al. Traumatic epidural haematomas of nonarterial origin: Analysis of 30 consecutive cases. Acta Neurochir (Wien) 2005;147(12):1241–8.
Cheung PS, Lam JM, Yeung JH, Graham CA, Rainer TH. Outcome of traumatic extradural haematoma in Hong Kong. Injury 2007;38(1):76–80.
Ruff LM, Mendelow AD, Lecky FE. Improving mortality after extradural haematoma in England and Wales. Br J Neurosurg 2013;27(1):19–23.
Ndoumbe A, Ekeme MVP, Jemea B, Simeu C, Takongmo S. Epidemiological Analysis of Surgically Treated Acute Traumatic Epidural Hematoma. Open J Modern Neurosurg 2016;6(3)89–97.
Sendilkumar A, Kannah E. Immediate prognostic outcome in traumatic epidural hematoma at a tertiary care centre. Int J Curr Res 2018;10(06):70085–90.
Bricolo AP, Pasut LM. Extradural hematoma: toward zero mortality. A prospective study. Neurosurgery 1984;14(1):8–12.
Lobato RD, Rivas JJ, Cordobes F, Alted E, Perez C, Sarabia R, et al. Acute epidural hematoma: an analysis of factors influencing the outcome of patients undergoing surgery in coma. J Neurosurg 1988;68(1):48–57. Ref no 11&19 are same
Stablein DM, Miller JD, Choi SC, Becker DP. Statistical methods for determining prognosis in severe head injury. Neurosurgery 1980;6(3):243–48.
Ndoumbe A, Ekeme MVP, Simeu C, Takongmo S. Outcome of Surgically Treated Acute Traumatic Epidural Hematomas Based on the Glasgow Coma Scale. Open J Mod Neurosurg 2008;8(1):109–18.
Krishna G, Beitchman JA, Bromberg CE, Currier Thomas T. Approaches to Monitor Circuit Disruption after Traumatic Brain Injury: Frontiers in Preclinical Research. Int J Mol Sci 2020;16;21(2):588.
Lingsma HF, Roozenbeek B, Steyerberg EW, Murray GD, Maas AI. Early prognosis in traumatic brain injury: from prophecies to predictions. Lancet Neurol 2010;9(5):543–54.
Murray GD, Butcher I, McHugh GS, Lu J, Mushkudiani NA, Mass AI, et al. Multivariable prognostic analysis in traumatic brain injury: results from the IMPACT study. J Neurotrauma 2007;24(2):329–37.
Rocchi G, Caroli E, Raco A, Salvati M, Delfini R. Traumatic epidural hematoma in children. J Child Neurol 2005;20(7):569–72.
Rivas JJ, Lobato RD, Sarabia R, Cordobes F, Cabrera A, Gomez P. Extradural hematoma: analysis of factors influencing the courses of 161 patients. Neurosurgery 1988;23(1):44–51.
Lobato RD, Rivas JJ, Cordobes F, Alted E, Perez C, Sarabia R, et al. Acute epidural hematoma: An analysis of factors influencing the outcome of patients undergoing surgery in coma. J Neurosurg 1988;68(1):48–57. Ref no 11&19 are same
Heinzelmann M, Platz A, Imhof HG. Outcome after acute extradural haematoma, influence of additional injuries and neurological complications in the ICU. Injury 1996;27(5):345–9.
Dubey A, Pillai SV, Kollur SVR. Does volume of extradural hematoma influence management strategy and outcome? Neurol India 2004;52(4):443–5.
Paterniti S, Falcone MF, Fiore P, Levita A, La Camera A. Is the size of an epidural haematoma related to outcome? Acta Neurochir (Wien) 1998;140(9):953–5.
van den Brink WA, Zwienenberg M, Zandee SM, van der Meer L, Maas AI, Avezaat CJ. The prognostic importance of the volume of traumatic epidural and subdural haematomas revisited. Acta Neurochir (Wien) 1999;141(5):509–14
Jamjoom A. The influence of concomitant intradural pathology on the hematoma and outcome of patients with acute traumatic extradural hematomas. Acta Neurochir (Wein) 1992;115(3-4):86–9.
Ellenbogen RG, Abdulrauf SI, Sekhar LN. Closed Head Injury. Principles of Neurological Surgery 3rd ed. chapter 20(vol 1): 2012; p.346.
Niaz A, Nasir MH, Niraula K, Majeed S, Neupane J, Ghimire M, et al. Factors affecting the surgical outcome in extradural hematoma in Punjab Institute of Neurosciences, Lahore, Pakistan. Nepal J Neurosci 2017;14(3):13–8.
Lee EJ, Hung YC, Wang LC, Chung KC, Chen HH. Factors influencing the functional outcome of patients with acute epidural hematomas: Analysis of 200 patients undergoing surgery. J Trauma 1998;45(5):946–52.
Rehman L, Karachi NJ. Association of Outcome of Traumatic Extradural Hematoma with Glasgow Coma Scale and hematoma size. Ann Pak Inst Med Sci 2010;6(3):133–8.
Ayogu OM, Onobun DE, Igbokwe KK, Ugwuanyi CU, Mordi CO, Ibeneme SA. Factors Affecting the Outcome of Traumatic Brain Injured Patients with Acute Epidural Haematoma in National Hospital, Abuja. J West Afr Coll Surg 2022;11(1):1–4.
Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical Management of Traumatic Brain Injury Author Group. Surgical management of acute epidural hematomas. Neurosurgery 2006;58(3):S7–15.
Emejulu JKC, Shokunbi MT, Malomo AO. Determinants of outcome in operative treatment of traumatic extradural haematoma. West Afr J Med 2008;27(1):32–6.
Ozkan U, Kemaloglu S, Ozates M, Guzel A, That M. Analyzing Extradural Haematomas: A retrospective clinical investigation. Dicle Tip Dergis 2007;34(1):14–9.
Cohen JE, Montero A, Israel ZH. Prognosis and clinical relevance of anisocoria-craniotomy latency for epiduralhematoma in comatose patients. J Trauma Acute Care Surg 1996;41(1):120–2.
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