Management Strategy and Outcome of Epidural Haematoma in Relation to Volume

Abstract

Epidural Haematoma (EDH) develops in 1-3% of all major head injuries and most common in the young. This crosssectional descriptive study was done to find out the management strategy and outcome of EDH in relation to clot volume. This study was performed from December'2006 to November'2007, by purposively selecting 77 cases of EDH from the Department of Neurosurgery, Dhaka Medical College Hospital (DMCH), Dhaka. The study showed that highest number of patients was in most active period of life, with male predominance (Male: Female =7.5:1). Causes of EDH were mostly due to assault (37.7%), followed by RTA (32.5%) and fall from height (29.8%). The study showed Patient having EDH Volume (EDHV) > 30ml will have 8.55 times more chance of having unfavorable outcome than patient having EDHV < 30 ml. Patient having EDHV > 30 ml will have 187.83 times more chance of requiring surgical intervention than those having EDHV <30 ml, which is statistically highly significant (p<0.001). Mortality rate of EDH can be reduced by giving early management either conservative or surgery. Delay in the management of EDH patients with poor level of consciousness and EDHV >30 ml has adverse effect on mortality and morbidity. Key words: EDH; EDHV; Burr hole; GOS; GCS. DOI: http://dx.doi.org/10.3329/fmcj.v6i2.9208 FMCJ 2011; 6(2): 89-91

Outcome of Traumatic Subarachnoid Hemorrhage in Patients Presenting to Neurosurgery Department Lady Reading Hospital Peshawar

“…Approximately 100 billion dollars are spent every year on patients of head injuries in United States. 2 195 patients fulfilled the inclusion criteria among which 37 (19%) patients age was < 20 years, 94 (48%) had 21-40 years, 45 (23%) were in age range of 41-60 years while 19 (10%) patients age was > 60 years. The mean age was 32 years ± 2.12 SD.…”

“…1 Approximately 100 billion dollars are spent every year on patients of head injuries in United States . 2 When a person sustains head injury the protocols of both basic and advanced life support are applied even at the site of the scene by prehospital person and it has a positive effect on the outcome of patients. It has been proved by the studies that application of ATLS protocols on head injury patients at the scene of injury are extremely important for patient's future functional outcome and betterment.…”

Extradural hematoma – is surgery always mandatory?

“…If neurological deterioration appears, surgical evacuation of the EDH should be performed as soon as [18,32]. In general, temporal or posterior fossa location of the EDH could be lethal by rapidity with which the patient can deteriorate clinically [2,15,30].…”

“…Although surgery remains the treatment of choice for many epidural hematomas, in the last decades more and more studies reporting conservative treatment of small and moderate sized hematomas having a good outcome appeared [12][13][14][15][16][17][18]. This management policy needs a close observation of the patient, both clinical and imagistic, as it is well known that even a previously stable patient's state can deteriorate rapidly.…”

“…This management policy needs a close observation of the patient, both clinical and imagistic, as it is well known that even a previously stable patient's state can deteriorate rapidly. Both the volume of extradural hematoma and the neurological status of the patient have been reported to influence the outcome of EDH [14][15][16]18].…”