Extradural haemorrhage: strategies for management in remote places

Prognostic factors in severely head injured adult patients with epidural haematoma's

“…There is a clear tread towards a better outcome in younger age groaps [I, 7, 8, i3, 20, 22, 23, 30, 31, 36], but statistical significance was shown only in two papers [16,38]. In two reports no significant relationship between age and outcome was found [19,35].…”

“…If patients whose injury looked hopeless are not sent to the neurosurgical centre [9] the reported results from these centres will underestimate mortality and morbidity and will not represent the overall population results. Only a few papers [37,38] have reported a referral area survey in the period of data collection. The aim of the present review is to evaluate relative prognostic criteria in patients comatose after head injury with an epidural haematoma and to formulate recommendations for improvement of therapy and suggestions for future research.…”

Prehospital Triage and Emergency Room Care in TBI

“…For instance, in Australia, neurosurgeons and neurointensivists are faced with the great challenge of managing head injuries over great distance. For this reason, a mobile neurosurgical service was recommended more than 2 decades ago for patients whose transport times are likely to be greater than 2 hours from a trauma center [76]. Subsequently, this system has been adopted in the official Neurosurgical Society of Australasia (NSA) and Royal Australasian College of Surgeons (RACS) neurotrauma guidelines [77].…”

Competing Priorities in the Brain Injured Patient: Dealing with the Unexpected

“…General surgeons may have to occasionally perform neurosurgery in remote locations for patients with TBI as statistics have shown that early simple interventions have resulted in increased rates of survival between 10-50%. 44, 45 Simpson et al have recommended evacuation of an extradural hematoma by the general surgeon in a remote location if the trauma center is >1-2 hours away. 44 Rinker et al advise emergency craniotomy if the GCS is <8, there are lateralizing signs such as a dilated pupil, hemiparesis or development of sustained bradycardia and hypertension.…”

“…44, 45 Simpson et al have recommended evacuation of an extradural hematoma by the general surgeon in a remote location if the trauma center is >1-2 hours away. 44 Rinker et al advise emergency craniotomy if the GCS is <8, there are lateralizing signs such as a dilated pupil, hemiparesis or development of sustained bradycardia and hypertension. 45 Immediate availability of neurosurgeons may not be essential if a properly trained and credentialed trauma surgeon can appropriately monitor patients for neurologic deterioration and facilitate early transfer to a center capable of full-time operative and postoperative neurosurgical care.…”