title: Traumatic extradural hematoma in enugu, Nigeria.
abstract: OBJECTIVE
  Acute traumatic extradural hematoma (EDH) is life threatening and requires prompt intervention. This is a study of incidence and outcome of consecutive patients with EDH managed in Enugu, Nigeria against a background of delayed referral.
  
  
  METHODS
  We retrospectively examined all consecutive trauma cases managed between 2003 and 2009 and analyzed patients with acute traumatic extradural hematoma in isolation or in combination with other intra cranial lesions. Age, sex, cause of injury, time of presentation, Glasgow Coma Score (GCS), pupil reactivity, treatment and clinical outcomes were determined.
  
  
  RESULTS
  Of 817 head injuries, 69 (8.4%) had EDH, a mean of 9.9 patients per year. Males were 57 (83%) and females 12 (17%). Peak age incidences were the second and third decades of life, with a mean age of 30.2 years. Causes were road traffic accidents (57%), assault (22%) and falls (9%). Twenty-six (38%) patients presented within 24 h of injury and only one patient presented within 4 h. The average time lag before presentation was 94.2 h. At presentation 39% had GCS of 13-15, 27% had 9-12 and 34% had 3-8. The most common location of hematoma was temporal (27.5%). Forty (59%) patients had surgery while 14 (20%) were managed conservatively. Ten patients (14.5%) died and of these 70% had GCS <8 and 60% had a seizure.
  
  
  CONCLUSIONS
  We conclude that early appropriate treatment of EDH results in good high quality survival (Glasgow Outcome Score 4 or 5). Low GCS should not be an absolute contraindication for surgery. Seizure prophylaxis should be considered in patients with GCS <8.
authors.affiliation: Department of Surgery, Neurosurgery Unit, University of Nigeria Teaching Hospital, Enugu, Nigeria.
authors.forename: Wilfred C
authors.initials: WC
authors.lastname: Mezue
authors.forename: Chika A
authors.initials: CA
authors.lastname: Ndubuisi
authors.forename: Mark C
authors.initials: MC
authors.lastname: Chikani
authors.forename: David S
authors.initials: DS
authors.lastname: Achebe
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Ohaegbulam
keywords: Demography; extradural hematoma; head injury; outcome
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