Delayed extradural hematoma after mild head injury: Report of three cases

Riesgo, Pedro; Piquer, José; Botella, Carlos; Orozco, Manuel Alejandro Meza; Navarro, J. Aparicio; Cabanes, J

doi:10.1016/s0090-3019(97)00194-8

Cited by 34 publications

(24 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Concurrent systemic traumatic lesions leading to a hypotensive state have been classically identified as a mechanism responsible for the delayed appearance of the epidural hematoma, a “tamponade” effect [2]. Nevertheless, our analysis showed such a direct correlation of PEDH with hypotension.…”

Section: Discussioncontrasting

confidence: 53%

“…A well recognized secondary insult of TBI is epidural hematoma (EDH), which is classically considered to be an acute complication of TBI whose maximum development takes place immediately following trauma [1]. However, there are also many reported cases of delayed/progressive epidural hematoma or very rare chronic epidural hematoma [2–4]. …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Progressive Epidural Hematoma in Patients with Head Trauma: Incidence, Outcome, and Risk Factors

Chen

Guo

Chen

et al. 2012

Emergency Medicine International

View full text Add to dashboard Cite

Progressive epidural hematoma (PEDH) after head injury is often observed on serial computerized tomography (CT) scans. Recent advances in imaging modalities and treatment might affect its incidence and outcome. In this study, PEDH was observed in 9.2% of 412 head trauma patients in whom two CT scans were obtained within 24 hours of injury, and in a majority of cases, it developed within 3 days after injury. In multivariate logistic regression, patient gender, age, Glasgow Coma Scale (GCS) score at admission, and skull fracture were not associated with PEDH, whereas hypotension (odds ratio (OR) 0.38, 95% confidence interval (CI) 0.17–0.84), time interval of the first CT scanning (OR 0.42, 95% CI 0.19–0.83), coagulopathy (OR 0.36, 95% CI 0.15–0.85), or decompressive craniectomy (DC) (OR 0.46, 95% CI 0.21–0.97) was independently associated with an increased risk of PEDH. The 3-month postinjury outcome was similar in patients with PEDH and patients without PEDH (χ 2 = 0.07, P = 0.86). In conclusion, epidural hematoma has a greater tendency to progress early after injury, often in dramatic and rapid fashion. Recognition of this important treatable cause of secondary brain injury and the associated risk factors may help identify the group at risk and tailor management of patients with TBI.

show abstract

Section: Discussioncontrasting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Progressive Epidural Hematoma in Patients with Head Trauma: Incidence, Outcome, and Risk Factors

Chen

Guo

Chen

et al. 2012

Emergency Medicine International

View full text Add to dashboard Cite

show abstract

“…[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] None of the patients would have been discharged under a strategy for mild head injury requiring a score of GCS 15. (2) 13 studies/126 cases-the complications occurred long after the head injury (mean 34 days, range 2 to 120 days).…”

Section: Resultsmentioning

confidence: 99%

Mild head injury: reliability of early computed tomographic findings in triage for admission

Geijerstam

Britton²

2005

Emergency Medicine Journal

View full text Add to dashboard Cite

Objective: To search the literature for case reports on adverse outcomes in patients with mild head injury where acute computed tomography (CT) findings had been normal. Methods: Mild head injury was defined as head trauma involving amnesia or loss of consciousness, but where neurological findings are normal on arrival at hospital (GCS 15). The scientific literature was systematically searched for case reports where an early CT was normal and the patient deteriorated within two days. In these cases, early discharge despite a normal CT head scan would have been hazardous. Results: Two prospective studies were found that investigated the safety of early CT in 3300 patients with mild head injury, as were 39 reports on adverse outcomes describing 821 patients. In addition, 52 studies containing over 62 000 patients with mild head injury were reviewed. In total, only three cases were deemed to have experienced an early adverse outcome despite a normal CT and GCS 15 on initial presentation. In another eight cases with incomplete descriptions, the interpretation was doubtful. Many reports of complications were not relevant to our question and excluded. These reports included cases with more severe head injury/not GCS 15 at presentation, complications that occurred after more than two days, or initial CT findings that were not fully normal. Conclusion: Very few cases were found where an early adverse event occurred after normal acute CT in patients with mild head injury. The strongest scientific evidence available at this time shows that a CT strategy is a safe way to triage patients for admission.

show abstract

“…In one study, Arienta et al stated that CT scan should be performed immediately on patients with at least one of the following criteria: insufficient consciousness, repeated vomiting, focal neurological findings, posttraumatic seizures, otorrhea, rhinorrhea, penetration injury, or a history of intracranial operation; and that, if considered necessary, delayed CT scan should be performed before discharge (12). A study by the Study Group on Head Injury of the Italian Society for Neurosurgery, on the other hand, stated that delayed CT scan need only be performed before discharging patients with minor head trauma receiving coagulopathy or still receiving anticoagulant treatment in the event of any lesion (21). In our study, delayed CT scan was performed on all 120 patients with a high-risk factor.…”

Section: Discussionmentioning

confidence: 99%