Clinical and Radiological Criteria for Surgery in Posttraumatic Extradural Hematoma: An Update from Central India.

Abstract

Background  The surgical management guidelines for any intracranial hemorrhage were objectively defined by the Brain Trauma Foundation (BTF) in 2006 for patients who should be treated surgically or conservatively. Since then, not much work has been done toward the identification of patients who are at high risk and may have progression of the hematoma who may ultimately require surgery. This study aimed to apply the said criteria to all patients coming to the hospital with extradural hematoma (EDH) and analyze the outcome of the patient whether treated conservatively or surgically on the basis of the Glasgow Outcome Scale (GOS) and to observe the factors and variables that are associated with EDH that will help in furthering the demographic design of the entity in central India. Materials and Methods  A prospective and retrospective, ambivalent cohort study was performed at a hospital in central India involving all cases of computed tomography (CT) diagnosed EDH that were reported to the center from October 2016 to March 2018. A total of 78 patients were included in the study. Patients were selected and managed conservatively or surgically as per the criteria and were followed up until the outcome. In retrospective analysis, we evaluated the current criteria for surgery in all patients of posttraumatic EDH in the past 5 years and whose records were available. Condition on discharge or the outcome along with GOS was taken as the endpoint for retrospective analysis. Results  Temporoparietal and frontal regions were the most common sites of EDH and also presented higher mortality rates as compared with other sites. The majority of patients had EDH of length of greater than 5 cm and the mortality rate for the same group also increased with lesser survival chances with length of greater than 10 cm. Patients who presented with an EDH of greater than 1-cm width were higher in numbers, with survival rates decreasing with an increase in width, especially with an EDH greater than 2 cm. Conclusion We conclude that the criteria laid out by the BTF, namely, CT findings of an EDH volume greater than 30 mL, width greater than 15 mm, and mildline shift of greater than 5 mm, hold good in cases of EDH. This study reviewed the previous criteria in the Indian setting and found them to hold good so far.