Identification of prognostic factors in surgically treated patients with acute epidural hematoma

Koki Onodera; Tomoya Kamide; Tatsuki Kimura; Shinya Tabata; Toshiki Ikeda; Yuichiro Kikkawa; Hiroki Kurita

doi:10.4103/ajns.AJNS_129_20

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(03): 532-536
DOI: 10.4103/ajns.AJNS_129_20

Original Article

Identification of prognostic factors in surgically treated patients with acute epidural hematoma

Authors

Koki Onodera

Department of Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama
Tomoya Kamide

Department of Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama
Tatsuki Kimura

Department of Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama
Shinya Tabata

Department of Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama
Toshiki Ikeda

Department of Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama
Yuichiro Kikkawa

Department of Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama
Hiroki Kurita

Department of Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama

Abstract

Context: Only few comprehensive studies have investigated acute epidural hematoma (AEDH), and a low incidence of the lesion has been observed in comparison with other types of traumatic brain injuries such as subdural hematoma, traumatic subarachnoid hemorrhage, and contusion. Aim: This study aims to identify the prognostic factors of surgically treated AEDH. Settings and Design: The medical records of 58 consecutive patients with surgically treated AEDH between September 2011 and 2018 were retrospectively reviewed. Subjects and Methods: All patients were diagnosed with AEDHs using 5-mm-slice computed tomography (CT). Information regarding the following demographic and clinical characteristics was collected: age, sex, antithrombotic drug use, mechanisms of injury, time from onset to operation, neurological examination, vital signs, blood examination, and CT findings. Statistical Analysis Used: We analyzed prognostic factors in patients with AEDH using univariate and multivariate regression analyses. Results: Univariate and multivariate regression analyses revealed that age (P < 0.01) and the Glasgow Coma Scale (GCS; P < 0.01) were independent predictive factors for good prognosis. In addition, receiver operating characteristics (ROC) analysis showed that an age of <55 years and a GCS score of >12 were optimal cutoff values for predicting good prognoses, with the areas under the ROC curve of 0.827 and 0.810, respectively. Conclusions: Age and GCS are useful predictors of prognosis in patients with surgically treated AEDH. These findings are appropriate prognostic indicators for urgent surgery performed to treat AEDH and intended to help clinicians make a prompt diagnosis.

Key-words:

Acute subdural hematoma - age of onset - Glasgow Coma Scale - prognostic factors - traumatic brain injury

Full Text

References

References
1 Ostermann RC, Joestl J, Tiefenboeck TM, Lang N, Platzer P, Hofbauer M. Risk factors predicting prognosis and outcome of elderly patients with isolated traumatic brain injury. J Orthop Surg Res 2018;13:277.
2 Kuhn EN, Erwood MS, Oster RA, Davis MC, Zeiger HE, Pittman BC, et al. Outcomes of subdural hematoma in the elderly with a history of minor or no previous trauma. World Neurosurg 2018;119:e374-82.
3 Kelly ML, Shammassian B, Roach MJ, Thomas C, Wagner AK. Craniectomy and craniotomy in traumatic brain injury: A propensity-matched analysis of long-term functional and quality of life outcomes. World Neurosurg 2018;118:e974-81.
4 McGinity MJ, Michalek JE, Rodriguez JS, Floyd JR. Surgical evacuation of acute subdural hematoma in octogenarians: A ten-year experience from a single trauma center. Br J Neurosurg 2017;31:714-7.
5 Fountain DM, Kolias AG, Lecky FE, Bouamra O, Lawrence T, Adams H, et al. Survival trends after surgery for acute subdural hematoma in adults over a 20-year period. Ann Surg 2017;265:590-6.
6 Orlando A, Levy AS, Carrick MM, Tanner A, Mains CW, Bar-Or D. Epidemiology of mild traumatic brain injury with intracranial hemorrhage: Focusing predictive models for neurosurgical intervention. World Neurosurg 2017;107:94-102.
7 Fu TS, Jing R, McFaull SR, Cusimano MD. Recent trends in hospitalization and in-hospital mortality associated with traumatic brain injury in Canada: A nationwide, population-based study. J Trauma Acute Care Surg 2015;79:449-54.
8 Kawabata S, Tani S, Imamura H, Adachi H, Sakai N. Postoperative subdural air collection is a risk factor for chronic subdural hematoma after surgical clipping of cerebral aneurysms. Neurol Med Chir (Tokyo) 2018;58:247-53.
9 Stavrinou P, Katsigiannis S, Lee JH, Hamisch C, Krischek B, Mpotsaris A, et al. Risk factors for chronic subdural hematoma recurrence identified using quantitative computed tomography analysis of hematoma volume and density. World Neurosurg 2017;99:465-70.
10 Wan X, Liu S, Wang S, Zhang S, Yang H, Ou Y, et al. Elderly patients with severe traumatic brain injury could benefit from surgical treatment. World Neurosurg 2016;89:147-52.
11 Hukkelhoven CW, Steyerberg EW, Rampen AJ, Farace E, Habbema JD, Marshall LF, et al. Patient age and outcome following severe traumatic brain injury: An analysis of 5600 patients. J Neurosurg 2003;99:666-73.
12 Rovlias A, Theodoropoulos S, Papoutsakis D. Chronic subdural hematoma: Surgical management and outcome in 986 cases: A classification and regression tree approach. Surg Neurol Int 2015;6:127.
13 Kwon CS, Al-Awar O, Richards O, Izu A, Lengvenis G. Predicting prognosis of patients with chronic subdural hematoma: A new scoring system. World Neurosurg 2018;109:e707-14.
14 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 hematoma: Analysis of 308 patients undergone surgery. Chin Med J (Engl) 2018;121:1080-4.
15 Taussky P, Widmer HR, Takala J, Fandino J. Outcome after acute traumatic subdural and epidural haematoma in Switzerland: A single-centre experience. Swiss Med Wkly 2008;138:281-5.
16 Kiboi JG, Kitunguu PK, Angwenyi P, Mbuthia F, Sagina LS. Predictors of functional recovery in African patients with traumatic intracranial hematomas. World Neurosurg 2011;75:586-91.
17 Moussa WM, Khedr WM, Elwany AH. Prognostic significance of hematoma thickness to midline shift ratio in patients with acute intracranial subdural hematoma: A retrospective study. Neurosurg Rev 2018;41:483-8.
18 Baum J, Entezami P, Shah K, Medhkour A. Predictors of outcomes in traumatic brain injury. World Neurosurg 2016;90:525-9.
19 Lenell S, Nyholm L, Lewén A, Enblad P. Clinical outcome and prognostic factors in elderly traumatic brain injury patients receiving neurointensive care. Acta Neurochir (Wien) 2019;161:1243-54.