Download PDF
CC BY 4.0 · WFNS Journal 2025; 02(01): e52-e62
DOI: 10.1055/a-2602-7387
Original Article

Clinical Outcome and Prognostic Factors of Surgically Treated Acute Epidural Hematoma, A 32-Month Prospective Observational Study

Biruk Mulugeta Kebede
1   Department of Neurosurgery, Wolaita Sodo University, Wolaita, Sodo, Ethiopia
,
Kaleab Getachew
1   Department of Neurosurgery, Wolaita Sodo University, Wolaita, Sodo, Ethiopia
,
Maihder Tewodros Bezu
2   Department of Radiology, Wolaita Sodo University, Wolaita, Sodo, Ethiopia
,
Mersha Abebe
3   Department of Neurosurgery, Addis Ababa University, Addis Ababa, Ethiopia
,
Tsegazeab Laeke
3   Department of Neurosurgery, Addis Ababa University, Addis Ababa, Ethiopia
› Author Affiliations
› Further Information
Also available at
  Permissions and Reprints

Abstract

Introduction

Traumatic brain injury (TBI) is a leading cause of death and disability in young individuals, with acute epidural hematoma (AEDH) being a critical neurosurgical emergency. Advances in CT imaging and surgical techniques have reduced mortality from 86 to 5 to 12%.

Objective

To assess the socio-demographic characteristics, clinical outcomes, and factors influencing prognosis in patients surgically treated for traumatic AEDH.

Methods

A prospective cross-sectional study was conducted on 132 patients treated for AEDH between February 2020 and September 2022 at Tikur Anbessa Specialized Hospital and ALERT Trauma Center. Data were collected through interviews, chart reviews, and CT scans, and analyzed using SPSS version 25.

Results

Of the 132 patients, 92.4% were male, with a mean age of 30.8 years. Assault (59.1%) and road traffic accidents (25.8%) were the leading causes. Most hematomas (98.5%) were supratentorial and unilateral (91.6%), with the parietal region most commonly affected (61.4%). Preoperative Glasgow Coma Scale (GCS) scores of 14 to 15 were observed in 48.5% of cases, and 89.75% of patients had normal pupillary reactions. The mortality rate was 3%, with 6.8% discharged in a vegetative state and 75% achieving good recovery (GODS: 7–8). Poor outcomes were significantly associated with low postresuscitation GCS (p = 0.004), effacement of basal cisterns (p = 0.043), hemiparesis (p < 0.001), low oxygen saturation (p = 0.007), and abnormal pupillary reactions (p = 0.014).

Conclusion

This study reports a low mortality rate in AEDH patients. However, key prognostic factors such as low GCS and pupillary abnormalities stress the need for rapid diagnosis and intervention to optimize outcomes.

Keywords

acute epidural hematoma - basal cistern - pupillary reaction - hemiparesis


Publication History

Received: 25 February 2025

Accepted: 05 May 2025

Accepted Manuscript online:
08 May 2025

Article published online:
28 May 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Biluts H, Kassahun A, Abebe M. Short term outcome of operated traumatic injury patients for intracranial hemorrhage. Ethiop Med J 2017; 6: 63-68
    Search in Google Scholar
  • 2 Ndoumbe A, Ekeme MVP, Simeu C, Takongmo S. Outcome of surgically treated acute traumatic epidural hematomas based on the Glasgow Coma Scale. Open J Mod Neurosurg 2018; 5 (23) 109-118
    Search in Google Scholar
  • 3 Jeong YH, Oh JW, Cho S. Korean Trauma Data Bank System Committee. Clinical outcome of acute epidural hematoma in Korea: preliminary report of 285 cases registered in the Korean Trauma Data Bank System. Korean J Neurotrauma 2016; 12 (02) 47-54
    PubMedSearch in Google Scholar
  • 4 Nnadi MON, Bankole OB, Fente BG. Outcome of surgically treated traumatic extradural hematoma. Br J Med Med Res 2016; 12 (01) 1-9
    Search in Google Scholar
  • 5 Araujo JLVAU, Aguiar UdoP, Todeschini AB, Saade N, Veiga JC. Epidemiological analysis of 210 cases of surgically treated traumatic extradural hematoma. Rev Col Bras Cir 2012; 39 (04) 268-271
    CrossrefPubMedSearch in Google Scholar
  • 6 Kiboi JG, Nganga HK, Kitunguu PK, Mbuthia JM. Factors influencing the outcomes in extradural hematoma patients. Ann Afr Surg 2015; 12 (01) 14-17
    Search in Google Scholar
  • 7 Dubey A, Pillai SV, Kolluri SV. Does volume of extradural hematoma influence management strategy and outcome?. Neurol India 2004; 52 (04) 443-445
    PubMedSearch in Google Scholar
  • 8 Khaled CN, Raihan MZ, Chowdhury FH, Ashadullah ATM, Sarkar MH, Hossain SS. Surgical management of traumatic extradural hematoma: experiences with 610 patients and prospective analysis. Indian J Neurotrauma 2008; 5 (02) 75-79
    Thieme ConnectSearch in Google Scholar
  • 9 Cock E. Two cases of injury to the head, followed by symptoms of compression produced respectively by extravasation of blood and formation of pus: relieved by operation. Guys Hosp Rep 1842; (07) 157-174
    Search in Google Scholar
  • 10 Hill J. . John Balfour. Cases in surgery, particularly of cancers, and disorders of the head from external violence, with observation; to which is added an account of the sibbens. J Edinbergh 1772. https://catalog.hathitrust.org/Record/009292358
    Search in Google Scholar
  • 11 Ratanalert S, Kornsilp T, Chintragoolpradub N, Kongchoochouy S. The impacts and outcomes of implementing head injury guidelines: clinical experience in Thailand. Emerg Med J 2007; 24 (01) 25-30
    PubMedSearch in Google Scholar
  • 12 Jung SWKD, Kim DW. Our experience with surgically treated epidural hematomas in children. J Korean Neurosurg Soc 2012; 51 (04) 215-218
    PubMedSearch in Google Scholar
  • 13 Azaj A, Seyoum N, Nega B. Trauma in Ethiopia revisited, a systematic review. East Cent Afr J Surg 2013; 18: 62-66
    Search in Google Scholar
  • 14 Tsegaye F, Abdella K, Ahmed E, Tadesse T, Bartolomeos K. Pattern of fatal injuries in Addis Ababa, Ethiopia: a one-year audit. East Cent Afr J Surg 2010; 15 (02) 26-32
    Search in Google Scholar
  • 15 Bricolo APPL, Pasut LM. Extradural hematoma: toward zero mortality. A prospective study. Neurosurgery 1984; 14 (01) 8-12
    CrossrefPubMedSearch in Google Scholar
  • 16 Seelig JMML, Marshall LF, Toutant SM. et al. Traumatic acute epidural hematoma: unrecognized high lethality in comatose patients. Neurosurgery 1984; 15 (05) 617-620
    PubMedSearch in Google Scholar
  • 17 McMillan TM, Weir CJ, Ireland A, Stewart E. The Glasgow outcome at discharge scale: an inpatient assessment of disability after brain injury. J Neurotrauma 2013; 30 (11) 970-974
    PubMedSearch in Google Scholar
  • 18 Aenderl I, Gashaw T, Siebeck M, Mutschler W. Head injury–a neglected public health problem: a four-month prospective study at Jimma University Specialized Hospital, Ethiopia. Ethiop J Health Sci 2014; 24 (01) 27-34
    PubMedSearch in Google Scholar
  • 19 KG. Observational study on the outcome of patients operated for traumatic extradural hematoma. Eur J Trauma Emerg Surg 2021; 47 (03) 847-853
    PubMedSearch in Google Scholar
  • 20 Singh AKA, Bindra GS, Gehlot AK, Midha R, Nandra K. Surgical outcome of 60 operated patients with acute extradural hematomas based on the preoperative Glasgow Coma Scale. Apollo Med 2019; 16: 26-32
    Search in Google Scholar
  • 21 Alakaishy AMK, Hejaju ASR, Shukri M. Traumatic extradural hematoma overview, clinical study and management. Int J Curr Res Acad Rev 2017; 5 (06) 110-116
    Search in Google Scholar
  • 22 Lee EJHY, Wang LC, Chung KC, Chen HH. Factors influencing the functional outcome of patients with acute epidural hematomas: analysis of 200 patients undergoing surgery. J Trauma 1998; 45 (05) 946-952
    CrossrefPubMedSearch in Google Scholar