Analysis of Factors Affecting Outcome of Acute Extradural Hematoma—Our Observation in Dhaka Medical College and Hospital

Abstract

Abstract Background Extradural hematoma (EDH) is a leading cause of death in young population. Timely intervention gives dramatic recovery but often fatal if not treated in time. The surgical outcome of EDH depends on many variables that strongly affect the prognosis of the disease, which are preoperative Glasgow coma scale (GCS), overlying skull fracture, time interval between injury and surgery, other associated intracranial injuries (like cerebral contusion, subdural hematoma, or intracerebral hematoma), pupillary abnormalities(anisocoria), and hematoma volume. But no correlation was found between surgical outcome of EDH and age, sex, etiology, and site of hematoma. Objective We want to identify the factors affecting the surgical outcome of EDH that will help us in preoperative prioritization of the cases for intervention, adequate resuscitation, and counselling the attendant regarding the outcome. Our ultimate goal was to reduce the mortality and morbidity from this disease. Methods This study was conducted on the patients admitted through neuroemergency and diagnosed as EDH by computed tomography scan of head, in the department of Neurosurgery of Dhaka medical college and hospital from January 1, 2017 to December 31, 2019. This is three-year prospective interventional study where all the patients underwent surgical evacuation of EDH on emergency basis and outcome was measured by Glasgow outcome scale (GOS) after 48 hours of admission and at discharge. Results Outcome was divided into good (GOS 4,5) and poor (GOS 1–3) groups. Pre-operative GCS, overlying skull fracture, time interval between injury and surgery, associated intracranial injuries, anisocoria and hematoma volume were the factors affecting the surgical outcome significantly. Conclusion Good surgical outcome is associated with EDH volume less than 40cc, pre-operative GCS more than 8, absence of anisocoria, overlying skull fracture, no associated intracranial injury and surgery within 12 hours of injury. But age, sex and site of EDH has no definite correlation with outcome.