Prognosis and clinical relevance of anisocoria-craniotomy latency for epidural hematoma in comatose patients.
OBJECTIVE
To determine whether the time between onset of anisocoria and surgery for hematoma evacuation in the head-injured patient is a useful prognostic variable for outcome in the comatose patient with an acute epidural hematoma.


METHODS
Prospective.


METHODS
Twenty-one patients with an acute traumatic epidural hematoma and an admission Glasgow Coma Scale score of less than 8 were analyzed.


RESULTS
Anisocoria was present in 14 (67%) patients. Mortality rate was three times higher in this group than in the patients without anisocoria; however, this difference was not statistically significant (p = 0.21, Fisher's exact test). None of the patients with an anisocoria-craniotomy latency of 70 minutes or less died and all of these patients had a good or reasonable outcome. Analysis of the anisocoria-craniotomy latency in ten patients revealed that a lapse of more than 90 minutes was associated with a greater mortality compared with patients with a latency of less than 90 minutes (p = 0.0238, Fisher's exact test).


CONCLUSIONS
In patients with an acute epidural hematoma, reducing the anisocoria-surgery interval below 90 minutes is significantly associated with a better outcome (p = 0.0238, Fisher's exact test).
Cohen
J E
JE
Department of Neurosurgery, Hospital de Emergencias Dr. Clemente Alvarez, Rosario, Argentina.
Montero
A
A
Israel
Z H
ZH
D000293:Adolescent; D000328:Adult; D000368:Aged; D015875:Anisocoria / Q000209:etiology*; D006259:Craniocerebral Trauma / Q000150:complications* / Q000401:mortality; D003399:Craniotomy; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome