Evaluation of Extradural Haematoma in Rural Population of Central India

Abstract

Introduction: Traumatic Brain Injury (TBI) is one of the leading health problem in India. Road Traffic Accident (RTA) forms the major bulk for TBI. Extradural Haematoma (EDH) occurs in 1-3% of total TBI patients. Being a rural setup where the study was conducted, data regarding the TBI from central India was scanty. It is the need of the hour to get the vital statistics regarding EDH from central Indian population. Aim: To evaluate EDH in TBI patients and to find the causes, clinical presentation, location of EDH and outcome in tertiary care setup of Central India. Materials and Methods: This was a retrospective study from January 2014 to January 2020. Patients admitted with EDH in Neurosurgery Department were included in the study. Eightyseven patients having EDH were identified and their records were retrospectively analysed. Various clinical parameters such as age, sex, duration of presentation to department after injury, clinical presentation, cause of injury, Glasgow Coma Scale (GCS) at time of presentation, location of EDH and management (conservative or surgery) were identified from case records. Descriptive statistical analysis was performed for above mentioned parameters in Microsoft excel 2016 along with SPSS 22.0 for applying chi-square test. Results: Out of 1,325 TBI patients, 87 had EDH. There were 79 males and eight females in the study with male to female ratio of 9.8:1. The peak age incidence was in third decade of life with mean age of 34.6 years (SD=22.14 years). Only 12 patients were presented within 6 hours of incident, while 24 patients presented within 6-24 hours and remaining 51 presented >24 hours after the event. RTA was the most common cause for EDH. Most common clinical presentation was headache followed by altered sensorium and vomiting. Most of the patients presented with GCS ranging from 13-15 (n=34, 39.08%) while the percentage of patients with GCS 3-7 was 33.33% (n=29). The most common location of haematoma was temporal. Surgical intervention was considered in 53 patients. Mortality in our study was 14.9%. Amongst the dead, 62% had seizure history (8 cases). Five out of thirteen patients died shortly after admission while four patient died while on conservative management. Conclusion: To conclude, RTA was the most common and preventable cause of EDH. Males had more chances of having EDH with peak age of incidence at third decade of life. Commonest location of EDH was temporal region. Early intervention in case of EDH can have good prognosis even in case of poor GCS. Poor GCS should not be the absolute contraindication for surgical intervention.

Keywords

• epidural haemorrhages
• intracranial epidural haematoma
• traumatic brain injury