Nonoperative management of epidural hematomas and subdural hematomas: is it safe in lesions measuring one centimeter or less?
BACKGROUND
Management of a patient with a closed head injury is based on neurologic status and computerized tomography scan results. We hypothesized that those patients with an epidural hematoma (EDH) or subdural hematoma (SDH) <1 cm in thickness could safely be treated nonoperatively.


METHODS
We retrospectively reviewed charts of 204 consecutive patients with either an EDH or SDH.


RESULTS
There were 122 lesions < or =1 cm and 82 lesions >1 cm. In the first group, 115 were managed nonoperatively, with 111 good outcomes (minimal deficit with a Rancho Los Amigos score [RLAS] > or =3), two poor outcomes (severely disabled with RLAS <3), and two deaths. Twenty-eight patients with lesions greater than 1 cm had concomitant cerebral edema (CE) with an 89% mortality rate. The mortality rate in this group without CE was 20%, demonstrating the presence of CE in this group may have adversely affected the mortality rate, regardless of intervention.


CONCLUSIONS
This data suggests that EDH or SDH <1 cm thick can be safely managed nonoperatively unless there is concomitant CE.
De Souza
Michelle
M
Department of Surgery, UMDNH-Robert Wood Johnson Medical School, Cooper University Hospital, Camden, NJ, USA.
Moncure
Michael
M
Lansford
Todd
T
Albaugh
Gregory
G
Tarnoff
Michael
M
Goodman
Martin
M
Endress
Ryan
R
Ross
Steven E
SE
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001930:Brain Injuries / Q000150:complications; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003399:Craniotomy; D005260:Female; D005500:Follow-Up Studies; D006407:Hematoma, Epidural, Cranial / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome