Traumatic Epidural Hematoma: Patient Characteristics and Management

• Published in: The American surgeon Vol. 83; no. 11; pp. 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: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.11.2017; SAGE PUBLICATIONS, INC
• Subjects: Computed tomography; Demographics; Epidural hematoma; Hematoma; Hospice care; Management; Medical imaging; Older people; Patients; Surgeons; Surgery; Trauma; Traumatic brain injury
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313481708301108

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.