Abstract
Background Absent pupillary reaction occasionally heralds a poor prognosis following severe
head injury. The purpose of the study was to evaluate the outcome of all patients
who underwent acute evacuation of epidural hematoma (EDH) despite absent bilateral
pupillary reaction.
Methods The Trauma Quality Improvement Program (TQIP) database for the calendar years 2017
and 2018 was accessed for the study. Adult patients ≥18 years of age who sustained
severe traumatic brain injury (TBI) with the diagnosis of EDH and underwent evacuation
of the hematoma were included in the study. The patients' characteristics, injury
severity score (ISS), Glasgow Coma Scale (GCS) score, midline shift, and comorbidities
were compared between patients who had absence of both pupillary reaction (ABPR) and
those who presented with presence of both pupillary reaction (PBPR). The primary outcome
of the study was in-hospital mortality. Propensity score matching analyses were performed
for the study.
Results No significant differences were found between the ABPR and PBPR groups regarding
the median age (37 years [interquartile range (IQR): 26–53] vs. 40 years [IQR: 28–55]),
gender (males; 81.9 vs. 79.5%), median ISS (29 [25.5–34] vs. 27 [25–33]), GCS score
(3 [3–4] vs. 3 [3–3], presence of significant midline shift (75.9 vs. 79.5%), and
comorbidities. The patients who presented with ABPR had a significantly higher mortality
(34.9 vs. 10.8%; p = 0.002). A higher number of patients were discharged to skilled nursing and rehabilitation
facilities (16.7 vs. 10.8% and 46.3 vs. 41.9%, respectively; p = 0.045).
Conclusion Approximately 65% of severe TBI patients survived after the evacuation of the EDH
despite the absence of pupillary reaction.
Keywords
epidural hematoma - severe traumatic brain injury - absent pupillary reaction - survival
