Abstract
Introduction: Extradural hematoma (EDH), a common sequela of traumatic brain injury, can lead to mortality and disability if there is a delay in identifying the pathology and subsequent management. In the 1920s, the mortality rate was reported as 86% and improved to 10% over the new millennium. We review our EDH cases to identify how we achieved zero mortality, which is the ultimate goal of EDH management.Methods: We retrospectively reviewed all traumatic EDH cases seen in the specialized pediatric neurosurgery department of Sabah Women & Children Hospital from January 2013 to August 2018. Patients’ case records, operative notes and radiological images were tracked and reviewed. A total of 101 cases were identified.Results: We had 101 patients ranging from the age of 9 months to 12 years. Fifty-eight patients (58.41%) were males, and 42 were females (41.59%). A total of 37 patients (36.3%) were treated surgically, and 64 patients (63.7%) were treated conservatively. About 92 patients (91.09%) presented with supratentorial EDH and 9 patients (8.91%) had infratentorial EDH. Skull fractures were present in 47 children (46.5%). In the pediatric age group, fall from heights was the most common cause. We achieved zero mortality among our patients who were treated both surgically and conservatively.Conclusion: EDH is a neurotrauma emergency that can be lethal, yet it is the most rewardingly responsive lesions treated by neurosurgeons. Early diagnosis, prompt referrals, early surgical intervention when indicated, and good intensive care remain the paramount facets towards achieving zero mortality in EDH. This study proves that our results are comparable to those seen in other neurosurgical centers throughout the developed world. An institutional protocol for EDH may ensure that the ultimate goal of towards ‘zero mortality’ could be achieved systematically and consistently.Keywords: conservative, extradural hematoma, pediatric, surgical, zero mortality
Highlights
Extradural hematoma (EDH), a common sequela of traumatic brain injury, can lead to mortality and disability if there is a delay in identifying the pathology and subsequent management
EDH is a neurotrauma emergency that can be lethal, yet it is the most rewardingly responsive lesions treated by neurosurgeons
This study proves that our results are comparable to those seen in other neurosurgical centers throughout the developed world
Summary
Extradural hematoma (EDH), a common sequela of traumatic brain injury, can lead to mortality and disability if there is a delay in identifying the pathology and subsequent management. Extradural hematoma (EDH), a collection of blood between the skull and the dura mater due to various causes of bleed, is a common sequela of head injury.[1,2,3] It is rare in children and can be fatal if not treated expeditiously.[4] As the nature of extradural hematoma is extracerebral, all patients should be saved This pathology becomes lifethreatening when it causes irreversible damage due to brain herniation and intracranial hypertension.[4,5] Computed tomography (CT) scanning has facilitated in making an early diagnosis and reducing mortality associated with EDH.[5,6] In a well-organized neurosurgical center, an excellent outcome should be achieved, and “zero mortality” would seem a fair target. A good outcome has been seen in patients treated for EDH at our center
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