Surgical Outcomes of Epidural Hematoma in Trauma Patients with Absent Pupillary Reactions

Abstract

Introduction: Absent pupillary reaction occasionally heralds a poor prognosis after severe head injury. The purpose of the study was to evaluate the outcome of patients who underwent evacuation of epidural hematoma despite absent pupillary reaction. Methods: The Trauma Quality Improvement Program (TQIP) database of the calendar of 2017_2018 was accessed for the study. Adult patients ≥18 years of age who sustained severe traumatic brain injury (TBI) with Glasgow Coma Scale (GCS) of 8 and below and underwent evacuation of epidural hematoma (EDH) were included in the study. The patients’ characteristics, injury severity score (ISS), GCS score, midline shift, and comorbidities were compared between patients who had absent bilateral pupillary reaction (PPR-) and who presented with bilateral pupillary reaction (PPR+). The primary outcome of the study was in-hospital mortality. Propensity matching analyses were performed for the study. Results: 83 patients in each group were included in the study. No significant differences found between the two groups, (PPR+) vs (PPR-), regarding median age (37 [IQR; 26-53] vs 40 [28-55]), sex [male] (81.9% vs 79.5%), median ISS (29 [25.5-34] vs 27 [25-33]), GCS score (3 [3-4] vs 3 [3-3], presence of significant midline shift (75.9% vs 79.5%) and comorbidities. The patients who presented with PPR- had significantly higher mortality (34.9% vs 10.8%, P = 0.002). A higher number of patients were discharged to skilled nursing and rehab facilities (16.7% vs, 10.8%, & 46.3% vs 41.9%, all p values= 0.045. Conclusion: Approximately 2/3rd of severe TBI patients survived after evacuation of EDH despite absent pupillary reaction.