Patient Profile and Outcomes of Traumatic Extradural Haematomas as Seen at The Nakuru Level Five Hospital in Kenya

Abstract

Background: An extradural haematoma (EDH) also referred to as epidural haematoma is a collection of blood between the skull and the dura. Extradural haematomas are present in 1-2% of all head injury patients. In those who present in coma, extradural haematomas are present in 10% of them. Mortality rates have been reported to range from 5-43% in different regions of the world. Mortality is reportedly nil in patients who present without coma and 20% for those who present comatosed. Methods: A prospective cross sectional descriptive study of patients diagnosed with extradural haematoma by CT scan conducted at the Nakuru level five hospital between 1 st January 2015 and 30 th November 2015. Descriptive patient demographic data, clinical presentation data, investigations, surgical treatments offered, length of hospital stay and outcomes were captured using a questionnaire. Results: A total of 32 patients with extradural haematoma were recruited into the study. There was a male preponderance that accounted for 96.8% of patients. Their ages ranged from 5 to 64 years with a mean age of 30.75 years (+ 13.6) and. The commonest cause of injury was assault at 31.3% of all head injury patients followed by motorcycle related accidents at 28.1%. There were 34.4% mildly injured patients, 43.8% moderate and 21.9% of patients severely head injured. There were 8 deaths (25%) of the patients and 59.4% of the patients had good recovery. Low GCS, rhinorhoea, otorhoea, presence of an intracerebral haematoma, admission to the ICU, convulsions and loss of consciousness were associated with poor outcome.( p=0.00, 0.001, 0.022, 0.002, 0.009, 0.000, and 0.044 respectively). Conclusion: The extradural haematoma patient is mostly a young male. The commonest cause of extradural haematoma is assault/violence related followed by motorcycle accidents. There is an important co relationship between Glasgow coma score and outcome. Likewise Convulsions, loss of consciousness at any time after injury, otorhoea , rhinorhoea and presence of associated injuries worsened outcomes in this subset of extradural haematoma patients.