Toward zero mortality in acute epidural hematoma: A review in 268 cases problems and challenges in the developing country

Abstract

Epidural hematoma (EDH) is one of the most life threatening lesion in patients with craniocerebral trauma. Traumatic extradural haematoma (EDH) is a neurosurgical emergency and timely surgical intervention for significant EDH is the gold standard. This study aims to determine the incidence and mortality of consecutive patients with traumatic EDH admitted to the Emergency Department (ED) of Dr. Soetomo General Hospital, Airlangga University in Surabaya. Retrospective analysis of prospectively collected data for all consecutive trauma cases admitted through the ED during January 2009–May 2012. EDH was diagnosed by CT in all cases. Both primary and delayed onset EDH were included, as were patients with combined EDH and other intracranial lesions (e.g. subdural haematoma). Age, sex, cause of injury, associated intracranial lesions, skull fracture, Glasgow Coma Scale, pupil reactivity, and clinical outcome were determined. We performed a chart review of 268 patients had complete data admitted to the emergency department with EDH diagnosed by CT scan and surgically treated between January 2009 and May 2012, mean of 15.41 patients per month. Seventy (77%) patients were male, with a mean age of 27.1 years. Sixty (73.86%) patients were from road traffic crashes, 40 (14.92%) sustained falls, 7 (2.61%) had direct head trauma. On admission, 81 (30%) patients were GCS 14–15, 116 (43%) GCS 9–13 and 71 (27%) GCS 3–8. Overall, 79 patients (29%) had anisocor pupils. Thirty-one patients (11.56%) died after neurosurgical operation. Outcome of EDH depends on the several factors, including trauma operation interval, patient's age, clinical status preoperative and associated other extracranial injury.