Outcomes of treatment for posttraumatic epidural hematomas

Relevance. Epidural hematomas occur in 8.2% of all patients with traumatic brain injury, more than half of whom require surgical treatment. Most patients with this condition have a favorable outcome with an uncomplicated clinical course. However, the clinical course of epidural hematomas depends mainly on the presence of additional intracranial injuries. There are few studies that compare in detail the results of treatment of isolated (without additional intracranial injuries) and combined (with additional intracranial injuries) variants of epidural hematomas.

Aim. Оf the study Analysis of treatment outcomes in patients with isolated and combined types of epidural hematomas.

Material and methods. We conducted a retrospective, single-center, cohort study at the Mariinsky City Hospital from April 2015 to December 2019. We included 129 patients in the study. 68 (52.7%) patients had the isolated version of epidural hematoma, 61 (47.3%) patients had the combined version of epidural hematoma. 81 (62.8%) patients were men, and 48 (37.2%) were women. The average patient age was significantly higher in the group with the combined version of epidural hematoma (48.3 years versus 32.7 years, p=0.001). The average follow-up time was more than 5 years.

Results. With increasing age, the combined variant of epidural hematoma had a higher incidence rate than the isolated variant of epidural hematoma. The in-hospital mortality rate in patients in the sample was 3.1%, in the group with the isolated variant of epidural hematoma 1.5% (1 patient), and 4.9% (3 patients) in the group with combined epidural hematoma. A good favorable outcome was achieved in 84 patients (65.1%), in the group with the isolated variant of epidural hematoma this figure was 88.2% (60 patients), in the group with the combined variant of epidural hematoma 41.4% (24 patients). Analysis of various additional intracranial injuries in patients with the combined variant of epidural hematomas did not reveal a significant difference in the results. Patients with isolated epidural hematoma had a statistically significantly lower risk of mortality (relative risk: 0.31; 95% CI: 0.11–0.41), and a statistically significantly lower risk of poor outcome according to the Glasgow Outcome Scale (GOS) (relative risk: 0.19; 95% CI: 0.11–0.29) than patients with combined epidural hematomas.

Conclusion. In general, patients with surgically treated isolated epidural hematomas have a positive favorable outcome. In addition, favorable outcomes can be achieved in 50% of cases in patients with combined epidural hematomas or isolated epidural hematomas with a low Glasgow Coma Scale (GCS) score. Therefore, every possible effort should be made to treat and achieve a favorable outcome in this potentially fatal injury.

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