MVP Journal of Medical Sciences

Open Access Open Access  Restricted Access Subscription Access

Clinical Evaluation and Management Outcome of Extradural Haematoma


Affiliations
1 Department of General Surgery, Dr. Vasantrao Pawar Medical College Hospital & RC, Nashik - 422003, India
 

Aims and Objective: The purpose of this study was to evaluate the clinical presentation of patient with extradural hematoma secondary to head injury and to decide upon the mode of management and also to study the results of the management and the outcome and the factors affecting morbidity and mortality. Materials and Methods: Data was collected through a prescribed proforma from the patients admitted in Surgery Department, Dr. Vasantrao Pawar Medical College and Hospital, Adgaon with extradural hematoma during the period of November 2014 to October 2016. The sample size of the study was 30 patients who completed the inclusion and exclusion criteria. All the patients with head injury on CT scan diagnosed to have EDH were included in the study. The management includes conservative measures and/or surgical intervention. The patients were followed for the results during the period of stay in hospital. Results: Temporo-Parietal (20%) and temporal region (20%) was the most common location of EDH. The most significant factors which influences surgical mode of management were higher age group, lower GCS and CT scan variables. Lower GCS was very significantly associated with unfavorable outcome along with CT scan variables irrespective of mode of management. Conclusion: From this study we concluded that neurological status of patient on presentation and the volumetric details of EDH are the most important factors in management and outcome of EDH. EDH patients were managed surgically and carried high number of unfavorable outcome previously. With early detection and treatment due to better connectivity of patients to hospitals, with the help of CT scan and good hospital care, we can expect a decrease in the number of unfavorable outcomes.

Keywords

Conservative Management, CT Scan, Extradural Hematoma, GOS, GCS, Surgical Management.
Font Size

User
Notifications

  • Mahapatra AK. Textbook of head injury. 2nd ed; p. 1.

  • Ramamurthi and Tandon’s Manual of Neurosurgery; p. 440.

  • Rengachary SS, Ellenbogen RG. Principles in Neurosurgery; p. 2081.

  • Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell. DW et al. Surgical management of acute epidural hematomas. Neurosurgery. 2006; 58(Supplement):52–7. https://doi.org/10.1227/01.NEU.0000210364.29290.C9

  • Thurman D, Guerrero J. Trends in hospitalization associated with traumatic brain injury. JAMA. 1999; 282:954–7. https://doi.org/10.1001/jama.282.10.954 PMid:10485680

  • Chowdhury NK, Raihan MZ, Chowdhury FH, Ashadullah ATM, Sarkar MH, Hossain SS. Surgical management of traumatic extradural haematoma: Experiences with 610 patients and prospective analysis. Indian Journal of Neurotrauma (IJNT). 2008; 5:75–9. https://doi.org/10.1016/ S0973-0508%2808%2980004-4

  • Bricolo A, Pasut L. Extradural hematoma: Towards zero mortality. A prospective study. Neurosurgery. 1984; 14:8–12. https://doi.org/10.1227/00006123-198401000-00003 PMid:6694798

  • Navdeep SS, Vikas R, Yashbir D, Grewal SS. Factors predicting outcome in patients with severe head injury: Multivariate analysis. IJNT. 2012; 9:45–8. https://doi.org/10.1016/j.ijnt.2012.04.009

  • Narayan RK, Greenberg RP, Miller JD, Enas GG. Improved confidence of outcome prediction in severe head injury. J Neurosurg. 1981; 54:751–62. https://doi.org/10.3171/jns.1981.54.6.0751 PMid:7241184

  • Kuday C, Uzan M, Hanci M. Statistical analysis of the factors affecting the outcome of extradural hematomas: 115 cases. Acta Neurochir (Wein). 1994; 131:203–6. https://doi.org/10.1007/BF01808613

  • Babu ML, Basin SK, Kumar A. Extradural hematoma an experience of 300 cases. JK Science. 2005 Dec; 7(4):205–7.

  • Sidram V, Kumar PCC, Bellara R, Rohith M. A study of clinic-radiological profile and outcome of extradural hematoma. A case series study.

  • Cook RJ, Dorsch NWC, Fearnside MR, Chaseling R. Outcome prediction in extradural hematomas. Acta Neurochirurgica. 1988; 90–4. https://doi.org/10.1007/BF01790766

  • Araujo JLV, Todeschini AB, Saade N, Veiga JCE. Epidemiological analysis of 189 cases of traumatic intracranial extradural hematoma treated by surgery. Revista Chilena de Neurocirugía. 2012; 38:25-8.

  • Tallon JM, Ackroyd-Stolarz S, Karim SA, Clarke DB. The epidemiology of surgically treated acute subdural and epidural hematomas in patients with head injuries: A populationbased study. Can J Surg. 2008 Oct; 51(5):339–45. PMid:18841222 PMCid:PMC2556533

  • Keet PC. Extradural hematoma. An analysis of two 8 year series at Gischolar_maine Schuur Hospital. SA Med J. 1984; 66:913–6. PMid:6505903

  • Bejjani GK, Donahue DJ, Rasin J, Broemeling LD. Radiological and clinical criteria for management. Pediatr Neurosurg. 1996; 25(6):302–8. https://doi.org/10.1159/000121144 PMid:9348150

  • Hamilton M, Wallace C. Nonoperative management of acute epidural hematoma diagnosed by CT: The neurodiagnostics role MJ. Neuoradio. 1992; 13:853–9.

  • Servadei F. Prognostic factors in severely head injured adult patients with acute subdural hematomas. Acta Neurochir (Wien). 1997; 139:279–85. https://doi.org/10.1007/BF01808822

  • Chen TY, Wong CW, Chang CN et al. the expectant treatment of asymptomatic supratentorial epidural hematoma. Neurosurgery. 1993; 32(2):176–9. https://doi.org/10.1227/00006123-199302000-00004 PMid:8437654

  • Dubey A, Pillai SV, Kolluri SVR. Does volume of extradural hematoma influence management strategy and outcome? Neurology India. 2004 Dec; 52(4):443–5. PMid:15626829

  • Gennarelli T, Spieman G, Langfitt T, Gildenberg P, Harrington T, Jane J, Marshall L, Miller J, Pitts L. Influence of the type of intracranial lesion on outcome from severe head injury. J Neurosurg. 1982; 56:26–32. https://doi.org/10.3171/jns.1982.56.1.0026 PMid:7054419


Abstract Views: 220

PDF Views: 93




  • Clinical Evaluation and Management Outcome of Extradural Haematoma

Abstract Views: 220  |  PDF Views: 93

Authors

Udaykumar Ramrao Badhe
Department of General Surgery, Dr. Vasantrao Pawar Medical College Hospital & RC, Nashik - 422003, India
Sudhir Bhamre
Department of General Surgery, Dr. Vasantrao Pawar Medical College Hospital & RC, Nashik - 422003, India

Abstract


Aims and Objective: The purpose of this study was to evaluate the clinical presentation of patient with extradural hematoma secondary to head injury and to decide upon the mode of management and also to study the results of the management and the outcome and the factors affecting morbidity and mortality. Materials and Methods: Data was collected through a prescribed proforma from the patients admitted in Surgery Department, Dr. Vasantrao Pawar Medical College and Hospital, Adgaon with extradural hematoma during the period of November 2014 to October 2016. The sample size of the study was 30 patients who completed the inclusion and exclusion criteria. All the patients with head injury on CT scan diagnosed to have EDH were included in the study. The management includes conservative measures and/or surgical intervention. The patients were followed for the results during the period of stay in hospital. Results: Temporo-Parietal (20%) and temporal region (20%) was the most common location of EDH. The most significant factors which influences surgical mode of management were higher age group, lower GCS and CT scan variables. Lower GCS was very significantly associated with unfavorable outcome along with CT scan variables irrespective of mode of management. Conclusion: From this study we concluded that neurological status of patient on presentation and the volumetric details of EDH are the most important factors in management and outcome of EDH. EDH patients were managed surgically and carried high number of unfavorable outcome previously. With early detection and treatment due to better connectivity of patients to hospitals, with the help of CT scan and good hospital care, we can expect a decrease in the number of unfavorable outcomes.

Keywords


Conservative Management, CT Scan, Extradural Hematoma, GOS, GCS, Surgical Management.

References





DOI: https://doi.org/10.18311/mvpjms%2F2018%2Fv5%2Fi1%2F11006