Extradural hematoma…an experience of series of cases in a tertiary care centre in asia

Aim: Acute traumatic extradural hematoma (EDH) is a life threatening problem and requires quick intervention. This is a retrospective study of incidence and outcome of consecutive patients with EDH managed in a tertiary care hospital in Asia.
Materials and Methods: We retrospectively examined all consecutive trauma cases managed between Jan 2014 and Dec 2016 and analyzed patients with acute traumatic extradural hematoma. These EDH patients had EDH in isolation or in combination with other intra cranial lesions. Cause of injury, time of presentation, age, sex, Glasgow Coma Score (GCS), pupil reactivity, treatment and clinical outcomes were also determined. Small thin rim EDH in patients whose GCS score was 15 were managed in conservative category. Those of the conservative category who did not behave well were operated upon and included in the operated category.
Results: Of 1971 head injuries, 81(7.5) had EDH, a mean of 27 patients per year. Males were 65 (80 percent) and females 16(20 percent). Peak age incidences were the second and third decades of life, with a mean age of 27 years. Causes were road traffic accidents in 55 (67.9%), falls in 11 (12.3%) assault in 8 (9.8%), cricket ball injury in 5 (6.1%) and unstated in (2.4%). In our series 70 (86.4%) patients presented within 24 h of injury. The average time interval before presentation was 9 hours. At presentation 22(27%) patients had GCS of 13-15, 36 (44.4%) had GCS 9-12 and 23 (28 %) had GCS less than 8. The most common location of hematoma was temporal (27.5%). 56 (69.1%) patients were managed by surgery. 25 (30.8%) patients were managed conservatively. In our series 3 patients (3.7%) died.
Conclusion: We conclude that early appropriate treatment of EDH results in good high quality survival. Low GCS. (Glasgow coma Score 4 or 5) should not be an absolute contraindication for surgery. The patients who have thin rim EDH in non-dangerous zone and in whom the GCS is 15 can be managed conservatively. Seizure prophylaxis should be considered in patients with GCS <8.