Factors with the strongest prognostic value associated with in-hospital mortality rate among patients operated for acute subdural and epidural hematoma

Abstract

Introduction Traumatic brain injury (TBI) still remains a serious health problem and is called a “silent epidemic”. Each year in Europe 262 per 100,000 individuals suffer from TBI. The most common consequence of severe head injuries include acute subdural (SDH) and epidural hematomas (EDH), which usually require immediate surgically treatment. The aim of our study is to identify factors which have the strongest prognostic value in relation to in-hospital mortality rate among of patients undergoing surgery for EDH and SDH. Patients and methods Cohort included 128 patients with isolated craniocerebral injuries who underwent surgery for EDH (28 patients) and SDH (100 patients) in a single, tertiary care Department of Neurosurgery. The data were collected on admission of patients to the Emergency Department and retrospectively analyzed. The following factors were analyzed: demographic data, physiological parameters, laboratory variables, computed tomography scan characteristics and the time between trauma and surgery. Likewise, we have investigated the in-hospital mortality of patients at the time of discharge. Results We found that the factors with the strongest prognostic values were: the initial GCS score, respiratory rate, glycaemia, blood saturation, systolic blood pressure, midline shift and type of hematoma. Additionally, we proved that a drop by one point in the GCS score almost doubles the risk of in-hospital death while the presence of coagulopathy increases the risk of in-hospital death almost six times. Conclusion Most of the factors with the strongest prognostic value are factors that the emergency team can treat prior to the hospital admission. Coagulopathy, however that has the strongest influence on in-hospital death rate can only be efficiently treated in a hospital setting.

The initial factors affecting in-hospital mortality rate of patients undergoing surgery for post-traumatic extra-axial hematomas

“…Computer tomography scan after TBI provides an objective assessment of a structural damage to the brain and can help in predicting prognosis (3,19). There is strong evidence that greater midline shift and the thickness of hematoma are associated with a higher mortality rate, our results also confi rm that (30,31,32).…”

“…The Glasgow Coma Scale (GCS) is the most common scale for assessing the patient's state of consciousness after a head injury. The age followed by the GCS motor score and the pupil response are most powerful independent prognostic factor after TBI (5,15) especially with extra-axial hematomas (3,14). In both groups GCS score was associated with in-hospital mortality with a statistically signifi cant difference.…”

“…Age is one of the most powerful independent prognostic factor (5) and increasing age was associated with a worse outcome and higher mortality (3,6), creating approximately linear function (7). The authors studying patients with extra-axial hematoma also found that increasing age was associated with a worse outcome and higher mortality rate (3,8,9,10). In our study in ADH and SDH group increasing age was associated with higher mortality rate too.…”

“…Treatment usually includes surgical removal of the hematoma (3). The prognosis after head injury is diffi cult to determine as it is captured in the Hippocratic aphorism, 'No head injury is too severe to despair of, nor too trivial to ignore' (3,4). In hospital mortality rate after this type of injury is diffi cult to predict, but usually high.…”

Medical Comorbidities Associated With Outcomes in Patients With Traumatic Epidural Hematomas

“…The use of illicit drugs and alcohol has been assessed in association with TBI, and a previously published literature review reported that nearly twothirds of TBI patients have a history of previous or current substance abuse, while approximately half are intoxicated at the time of injury [8]. It is important to note that drug and alcohol intoxication at the time of injury has mixed results within the literature in relation to mortality rates, but is associated with decreased functional outcomes [3,[9][10][11]. Furthermore, history of substance abuse has been correlated with TBI outcomes, including mortality, long-term functional outcomes, and other complications [10].…”