Impact of interhospital transport on outcome in traumatic epidural hematoma: experiences of a level-1 trauma center.

Abstract

Background: Epidural hematomas (EDH) are associated with a high rate of mortality and morbidity. Good clinical outcome depends on initial Glasgow Coma Scale (GCS), pupillary abnormalities, hematoma volume, age and time to surgery. The latter is mostly influenced by distance to the next level-1-trauma center.

Objective: The aim of this study was to evaluate the surgical care and the influence of a potential interhospital transport of patients with acute EDH.

Material & methods: A retrospective analysis of data from 2009 to 2020 was carried out. All patients who underwent surgical evacuation of an EDH were included. Time and distance to surgery, pupillary abnormalities, initial GCS, age at surgery, direct or indirect transport, outcome (GOS) and comorbidities were collected. The effect on outcome was analyzed by multivariate analysis.

Results: One hundred and thirty-one patients (106 men, 25 women) with EDH were surgical treated at our department. 54% were transported directly to our hospital. Median time to surgery was 4 h (2-336 h) and mean distance was 50 km (road kilometers). There was no difference in surgical treatment between admission patterns. Secondarily transferred patients have been operated at least as fast than primary hospital admissions (median 10 h vs. 11 h, respectively). Direct or indirect transport of patients had no statistically significant influence on outcome (p = 0.72), like sex (p = 0.33) and time to surgery (p = 0.75).

Conclusion: Interhospital transport did not cause a significant delay of surgical treatment and outcome was comparable between direct and indirect transport to specialized neurosurgical care. Direct transport was more common on severe TBI and in patients with pupillary abnormalities, but secondary transport also allowed for adequate care.