Traumatic Epidural Hematoma: Patient Characteristics and Management

Determinants for surgical or nonsurgical management of EDH are based on neurological status, clinical exam, size/volume, computer tomography (CT) scan findings and neurosurgeon judgement.2-4 There is a growing body of literature to support nonsurgical management of EDH in select situations1-4; there...

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Bibliographic Details
Published in:The American surgeon 2017-11, Vol.83 (11), p.438-440
Main Authors: Rosenthal, Andrew A., Solomon, Rachele J., Eyerly-Webb, Stephanie A., Sanchez, Rafael, Lee, Seong K., Kiffin, Chauniqua, Davare, Dafney L., Hranjec, Tjasa, Carrillo, Eddy H.
Format: Article
Language:English
Subjects:
Computed tomography
Demographics
Epidural hematoma
Hematoma
Hospice care
Management
Medical imaging
Older people
Patients
Surgeons
Surgery
Trauma
Traumatic brain injury
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Summary:Determinants for surgical or nonsurgical management of EDH are based on neurological status, clinical exam, size/volume, computer tomography (CT) scan findings and neurosurgeon judgement.2-4 There is a growing body of literature to support nonsurgical management of EDH in select situations1-4; therefore, we sought to review our experience with traumatic EDH and study the demographics of our EDH patient population, delineate physiologic and anatomic factors associated with surgical intervention (craniotomy or craniectomy), and evaluate outcomes for both our surgical and nonsurgical populations. Factors influencing surgical intervention included young age, low GCS, large hematoma size on CT ($1 cm), and EDH progression on follow-up CT scan. Similar to previous studies, patient age was also a significant factor in the decision to operate, as older patients were frequently treated nonsurgically; this may be attributed to greater adherence of the dura mater to the skull in elderly patients, reducing the potential epidural space for blood accumulation.1 Significant neurological improvement was seen in both the surgical and nonsurgical groups, while disposition and survival outcome were not correlated with intervention.
ISSN:0003-1348
1555-9823
DOI:10.1177/000313481708301108