Determinants of outcome in operative treatment of traumatic extradural haematoma

Background: Traumatic extradural haematoma is a rare condition and treatment in a majority of cases is by operative evacuation. Outcome from treatment is influenced by several factors. Objective: To evaluate the operative treatment of traumatic extradural haematoma in our centre and assess the impact on outcome of some of the historical factors. Methods: A retrospective study of cases managed January 1993 - February 2004 using records from the Emergency Room, Wards, Theatre and Radiology Unit. Only the cases definitively diagnosed as extradural haematoma resulting from trauma and had operative evacuation, were recruited. The Glasgow Coma Scale was used to measure the severity of injury; whereas post-operative outcome was considered good in those with minimal or no neurological deficits. Collated data were analyzed and the patients were divided into 3 groups - good, moderate and fatal (poor) based on the outcome; the impact of the various historical factors was compared among the groups. Statistical analysis was done using the chi-square test and p-value of 0.05 or less was considered significant. Results: Majority of the patients were young, with mild head injury and good outcome, and a surprisingly long mean preoperative time lag of 123.1hours. Outcome was good in 24 (64.9%), moderate 6(16.2%) and fatal 7(18.9%). There were skull fractures in 26 (70.3%), but there was no significant difference in outcome among those with and those without fractures. Conclusion: Age of the patient and severity of head injury (a reflection of concomitant brain injuries), more than other factors appear to dominantly prognosticate outcome from operative evacuation in our service.