gms | German Medical Science

Objective: Larger case series reviewing cohorts > 100 patients with EDH report data from more than 25 years ago. Outcome of EDH is thought to be depending on several clinical and radiological parameters. The aim of this study is to reevaluate if these paradigms have changed with regard to modern structures of resuscitation and chain or survival. Patients with TBI resulting from EDH in modern times might be different regarding age, co – morbidities and coagulation status. We analyzed predictors for outcome in patients with EDH treated by surgery.

Methods: A retrospective observational analysis was carried out. All included patients underwent surgery. Indication for surgery followed international guidelines. Retrospective data assessment obtained data reflecting the effectiveness of the chain of survival (arterial blood pressure on the scene, shock index and time interval between resuscitation on the scene and arrival in the emergency department), baseline characteristics (age, sex, abnormality in pupillary diameter, coagulopathy, degree of polytrauma using the injury severity score (ISS), neurological status, radiological findings and laboratory values. For the analysis we dichotomized patients into two groups with isolated EDH and the control group comprises EDH plus other intracranial traumatic injuries. The neurological outcome was measured by Glasgow Outcome Scale at discharge.

Results: 268 patients with EDH were treated from January 1997 until December 2012, 132 of which underwent surgery. The majority of patients with isolated EDH (65 % of all patients) had mild TBI (GCS 13 – 15), 19 % were comatose. The overall mortality was 6.8% (mortality for patients with GCS < 9 - 15 %). As expected, factors with a high significant (p<0.01) impact on outcome were concomitant other intracranial injuries, brain midline shift and higher ISS reflecting a higher degree of polytraumatization. Alcohol intoxication was a significant (p<0.05) predictor for unfavorable outcome (GOS 1-3). Interestingly, anticoagulants and GCS at admission had no significant impact on the outcome. A subgroup analysis of the patients in which the elements of the chain of survival are thought to play a crucial role (GCS < 8, patients, patients with high ISS) show that the most relevant factor for favorable outcome is the duration from the primary treatment on the scene until the arrival in the emergency room. Comparing our cohort with older published data in a matched pair fashion regarding the GCS showed that the outcome in improved over the years.

Conclusion: The outcome of EDH is more favorable than decades ago most probably reflecting a well established chain of survival especially in patients with a high degree of polytraumatization and a low GCS. Anticoagulation does not play a decisive role for outcome. EDH presents a well treatable disease with a high chance for favorable outcome especially for patients with isolated EDH.