Summary
Since 1988 in the referral area of the Neurosurgical Unit of Cesena, Italy, a protocol for prevention of deterioration in minor head injury was adopted. Adult patients admitted to any hospital with a GCS score of 15 and 14 (transient) without neurological deficit are submitted to skull x-ray: if a fracture is present the patient is sent for CT to the nearest regional Center. In children skull x-ray is not routinely performed and the patients are admitted for observation to the nearest regional hospital.
To assess the effects of such a protocol on morbidity and mortality of extradural haematoma (EDH), from June 1989 to September 1991 a consecutive series of 95 patients harbouring a significant acute EDH was collected. Mean age was 31 years; in 70% trauma was caused by a road traffic accident. The patients were divided into 3 categories:
-
a)
Clinical deterioration: mean GCS at surgery was 7.7; out of 27 patients, 12 had anysocoria and 3 bilaterally fixed pupils; the outcome showed only two deaths, one related to the EDH and the other to cardiac arrythmia. Most of the patients deteriorated either during transport after being recognized as at risk or already in Neurosurgery allowing rapid surgical treatment.
-
b)
Impaired consciousness (18 cases) and
-
c)
Minor head injury (50 cases) are groups of patients treated without morbidity and mortality.
If we compare these results with those of a previous study of our group done in 1980–86, there is a statistically significant difference concerning both mortality and morbidity. Our protocol proved therefore to be adequate in preventing most deaths that occurred following clinical deterioration in an apparently low risk patient.
Similar content being viewed by others
References
Andrews BT, Pitts LH (1991) Functional recovery after traumatical transtentorial herniation. Neurosurgery 29: 227–231
Aoki N (1986) Air in acute epidural hematoma: report of two cases J Neurosurg 65: 555–556
Bricolo AP, Pasut LM (1984) Extradural hematoma: toward 0 mortality. Neurosurgery 14: 8–12
Bucci MN, Phillips TW, McGillicuddy JE (1986) Delayed epidural hematoma in ipotensive multiple trauma patients. Neurosurgery 19: 65–68
Chan KH, Mann KS, Yue CP, Fan YN, Cheung M (1990) The significance of skull fracture in acute traumatic intracranial haematomas in adolescents: a prospective study. J Neurosurg 72: 189–194
Cordobes F, Lobato R, Rivas JJ, Munoz MJ, Chillon D, Portillo J, Lamas E (1981) Observations on 82 patients with extradural hematomas. J Neurosurg 54: 179–186
Dacey RG, Wayne AM, Rimel RW, Wim R, Jane JA (1986) Neurosurgical complication after apparently minor head injury: assessment of risk in a series of 160 patients. J Neurosurg 65: 203–210
Edna TH (1983) Acute traumatic intracranial haematoma and skull fracture. Acta Chir Scand 149: 449–451
Hamilton M, Wallace C (1992) Non-operative management of acute epidural hematoma diagnosed by CT: the neuroradiologist's role. AJNR 13: 853–859
Hooper RA (1959) Observations on extradural haemorrhage. Br J Surg 47: 71–87
Jennett B, Bond M (1975) Assessment of outcome after severe brain damage: a practical scale. Lancet 1 480–485
Klauber MR, Marshall LF, Luerssen TG, Owski R, Tabbador K, Eisenberg HM (1989) Determinants of head injury mortality: importance of low risk patients. Neurosurgery 24: 31–36
Knuckey NW, Gelbard S, Epstein MH (1989) The management of asymptomatic epidural hematomas: a prospective study. J Neurosurg 70: 392–396
Lee ST, Lui TN (1991) Delayed intracranial haemorrhage in patients with multiple trauma and shock related hypotension. Acta Neurochir (Wien) 113: 121–124
Marshall LF (1988) Asymptomatic acute bilateral epidural hematoma (Comment) Neurosurgery 23: 42
McKissock W, Taylor JC, Bloom WH, Till K (1960) Extradural haematoma: observation in 25 cases. Lancet 2: 167–172
McLaurin RL, Ford LE (1964) Extradural haematoma: statistical survey of 47 cases. J Neurosurg 21: 364–371
Mann KS, Chan KH, Yue CP (1986) Skull fractures in children: their assessment in relation to developmental skull changes and acute intracranial hematomas. Childs Nerve Syst 2: 258–261
Mendelow AD, Teasdale G, Jennett B, Bryden J, Hasset C, Murray G (1983) Risks of intracranial haematoma in head injured adults. BMJ 287: 1173–1176
Miller JD (1986) Minor, moderate and severe head injury. Neurosurg Rev 9: 135–139
Poon WS, Poon CYS, Li AKC (1992) Traumatic extradural hematoma of delayed onset is not a rarity. Neurosurgery 30: 681–686
Sakai H, Takagi H, Ohtaka H, Tanabe T, Ohwada T, Yada K (1988) Serial changes in acute extradural hematoma size and associated changes in level of consciousness and intracranial pressure. J Neurosurg 68: 566–570
Seelig JM, Marshall LF, Toutant SM, Toole BM, Klauber MR, Bowers SA, Vernell JA (1984) Traumatic acute epidural hematoma: unrecognized high lethality in comatose patients. Neurosurgery, 15: 617–620
Servadei F, Piazza GC, Seracchioli A, Acciarri N, Pozzati E, Gaist G (1988) Extradural haematomas: an analysis of the changing characteristics of patients admitted from 1980 to 1986. Diagnostic and therapeutic implication in 158 cases. Brain Injury 2: 87–100
Servadei F, Ciucci G, Morichetti A, Pagano F, Burzi M, Staffa G, Piazza GC, Taggi F (1988) Skull fracture as a factor of increased risk in minor head injuries. Surg Neurol 30: 364–369
Servadei F, Faccani G, Roccella P, Seracchioli A, Godano U, Ghadirpour R, Naddeo M, Piazza G, Carrieri P, Taggi F (1989) Asymptomatic extradural haematomas. Results of a multicenter study of 158 cases in minor head injury. Acta Neurochir (Wien) 96: 39–45
Servadei F (1991) Computed tomographic examination in minor head injury. Letter. Lancet 337: 788–789
Smith HR, Miller JD (1991) The danger of an ultra early computed tomographic scan in a patient with an evolving acute epidural hematoma Neurosurgery 29: 258–260
Stein SC, Ross SE: (1990) The value of computed tomographic scans in patients with low risk head injury. Neurosurgery 26: 638–640
Stein SC, Ross SE (1992) Moderate head injury: a guide to initial management. J Neurosurgery 77: 562–564
Teasdale GM, Murray G, Anderson E, Mendelow AD, MacMillan R, Jennett B, Brookers M (1990) Risks of acute intracranial haematoma in children and adults: implications for managing head injuries. BMJ 300: 363–367
Zimmerman RA, Bilaniuk LT (1982) Computed tomographic staging of traumatic epidural bleeding. Radiology 144: 809–812
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Servadei, F., Vergoni, G., Staffa, G. et al. Extradural haematomas: How many deaths can be avoided?. Acta neurochir 133, 50–55 (1995). https://doi.org/10.1007/BF01404947
Issue Date:
DOI: https://doi.org/10.1007/BF01404947