title: The challenges of managing acute extradural hematoma in a Nigerian neurosurgical center--still a long way to go.
abstract: BACKGROUND
  Acute extradural hematoma (EDH) is the collection of blood in the potential space between the dura mater and endocranium within 3 days of an incident. It is usually, but not always, a neurosurgical emergency, and early treatment reduces morbidity and mortality, although the outcome is still affected by some other determinants. In Nigeria, the National Health Insurance Scheme does not cover neurosurgical cases, and patients have to pay for all of their treatment regardless of the emergency status. We evaluate epidemiologic patterns, management protocols, and outcome, especially in relation to timely operative intervention, in patients with acute extradural hematoma who presented to our recently established neurosurgical service.
  
  
  METHODS
  This prospective study comprised cases managed in our center from May 2006 to July 2013. Data of all patients with acute EDH were collected on Microsoft Excel software and complemented with hospital charts and operative records. Demographic data, etiologic factors, time interval from injury to presentation in our service, time interval from presentation to definitive treatment, and outcome were collected and analyzed.
  
  
  RESULTS
  Within the 86-month study period, 1648 patients presented to our service with head injuries. Acute EDH constituted 3.03%, with a mean of 7.14 cases per year. Among the cases of acute EDH, 92% involved male patients (male-to-female ratio, 11.5:1). Peak age incidence (42%) was 21-30 years (mean, 23 years), and motorcycle road traffic accident was the most common etiologic factor (72%). Operative treatment was performed in 84% of the cases (in 57.1%, operative treatment occurred within 1 week of presentation). Conservative management was employed in 10% of cases. Mortality was 14.9%; most (10%) had severe head injury, although 2.1% had mild injury known to be associated with 0% mortality.
  
  
  CONCLUSIONS
  Acute EDH is a potentially fatal condition that is easily treatable if presentation, diagnosis, and treatment occur promptly. Our outcomes could be improved if the present logistics associated with the cash-and-carry health care delivery system in Nigeria could be reduced or obviated.
authors.affiliation: Neurosurgery Unit, Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria. Electronic address: judekenny2003@yahoo.com.
authors.forename: Jude Kennedy C
authors.initials: JK
authors.lastname: Emejulu
authors.affiliation: Neurosurgery Unit, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Enugu, Nigeria.
authors.forename: Enoch Ogbonnaya
authors.initials: EO
authors.lastname: Uche
authors.affiliation: Plastic Surgery Unit, Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria.
authors.forename: Ezekiel Uche
authors.initials: EU
authors.lastname: Nwankwo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000150:complications / Q000453:epidemiology; D019090:Case Management; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006407:Hematoma, Epidural, Cranial / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D019635:Neurosurgical Procedures / Q000191:economics / Q000379:methods*; D009549:Nigeria / Q000453:epidemiology; D011446:Prospective Studies; D055815:Young Adult
keywords: Computed tomography; Male gender; Mortality; Operative treatment