Prognostic Value of Swirl Sign in Acute Epidural Hemorrhage

Abstract

Objective The purpose of this study is to analyze and evaluate the incidence, prognostic value, and impact of swirl sign on the outcome of patients who underwent surgical treatment for epidural hematoma.

Materials and Methods A retrospective analytical study on 307 acute epidural hematoma (AEDH) patients with and without swirl sign was conducted at our hospital between 2015 and 2019. All the patients in this study were treated initially as per the protocols of advanced trauma life support and surgically treated by craniotomy and evacuation of epidural hematoma. Patients with other concomitant intracerebral injuries such as subdural hematoma and contusion and those who were managed conservatively were excluded from the study. Various factors such as age, sex, mechanism of injury, Glasgow Coma Scale (GCS) score at admission, time from injury to surgery, preoperative mydriasis, location of bleed, midline shift, location of fracture, volume of hematoma, duration of stay in the hospital, and GCS score at discharge were taken into consideration and compared in between patients with and without swirl sign. Outcomes were assessed at the end of 6 months using the Glasgow Outcome Scale.

Results Of the 307 patients who were operated for epidural hemorrhage, 92 had swirl sign (29.96%) and the rest had no swirl sign. Univariate analysis revealed a significant correlation between the presence of swirl sign and age, preoperative mydriasis, and time from injury to surgery. The patients with the swirl sign had an unfavorable outcome at the end of 6 months which was statistically significant.

Conclusion It can be concluded that those patients with swirl sign in AEDH had an unfavorable outcome compared to those without swirl sign. Therefore, aggressive treatment and early surgery play an important role in the outcomes of the patients.

Keywords

Acute - epidural hematoma - outcome - prognosis - surgery - swirl sign

Publikationsverlauf

Artikel online veröffentlicht:
15. November 2022

• References

• 1 Greenberg J, Cohen WA, Cooper PR. The “hyperacute” extraaxial intracranial hematoma: Computed tomographic findings and clinical significance. Neurosurgery 1985; 17: 48-56
• 2 Ono J, Yamaura A, Kubota M, Okimura Y, Isobe K. Outcome prediction in severe head injury: Analyses of clinical prognostic factors. J Clin Neurosci 2001; 8: 120-123
• 3 Lee EJ, Hung YC, 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: 946-952
• 4 Guo C, Liu L, Wang B, Wang Z. Swirl sign in traumatic acute epidural hematoma: Prognostic value and surgical management. Neurol Sci 2017; 38: 2111-2116
• 5 Tian HL, Chen SW, Xu T, Hu J, Rong BY, Wang G. et al. Risk factors related to hospital mortality in patients with isolated traumatic acute subdural haematoma: Analysis of 308 patients undergone surgery. Chin Med J (Engl) 2008; 121: 1080-1084
• 6 Araujo JL, Aguiar Udo P, Todeschini AB, Saade N, Veiga JC. Epidemiological analysis of 210 cases of surgically treated traumatic extradural hematoma. Rev Col Bras Cir 2012; 39: 268-271
• 7 Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW. et al. Surgical management of acute epidural hematomas. Neurosurgery 2006; 58: S7-15
• 8 Paiva WS, Andrade AF, Mathias Jr. L, Guirado VM, Amorim RL, Magrini NN. et al. Management of supratentorial epidural hematoma in children: Report on 49 patients. Arq Neuropsiquiatr 2010; 68: 888-892
• 9 Yilmazlar S, Kocaeli H, Dogan S, Abas F, Aksoy K, Korfali E. et al. Traumatic epidural haematomas of nonarterial origin: Analysis of 30 consecutive cases. Acta Neurochir (Wien) 2005; 147: 1241-1248