title: Risk Factors for the Development of Contralateral Epidural Hematoma Following Decompressive Craniectomy in Patients with Calvarial Skull Fracture Contralateral to the Craniectomy Site.
abstract: OBJECTIVE
  To investigate the frequency and risk factors of contralateral epidural hematoma (CEDH) following decompressive craniectomy (DC) in patients with calvarial skull fracture contralateral to the craniectomy site.
  
  
  METHODS
  After reviewing the medical records and radiographs over a 5-year period, 72 patients with calvarial fracture contralateral to the craniectomy site were enrolled to determine the risk factors for the development of CEDH following DC.
  
  
  RESULTS
  Among 13 patients with CEDH following DC, all but 1 patient were younger than 60 years of age. In 10 patients (77%) with CEDH, the contralateral calvarial fracture involved more than 1 bone plate. Comparatively, contralateral calvarial fracture involving more than 1 bone plate was noted in 21 patients (35.6%) without CEDH. After multiple logistic regression analysis, only age (P = 0.008, odds ratio [OR] = 0.916, 95% confidence interval [CI] = 0.858-0.987) and number of fracture-involved bone plate (P = 0.006, OR = 10.971, 95% CI = 2.02-59.70) remained independently associated with CEDH development following DC, and CEDH development rate increased by 8.4% with every 1-year decrease in age.
  
  
  CONCLUSIONS
  Age and number of fracture-involved bone plate are significant risk factors for CEDH development following DC. Involvement of 2 or more bone plates of contralateral calvarial skull fracture in young adult may prompt an immediate postoperative computed tomography scan to detect the occurrence of CEDH, irrespective of the operative findings and neurologic status. This may prevent devastating neurologic consequences of CEDH and improve therapeutic outcome.
authors.affiliation: Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Tsung-Ming
authors.initials: TM
authors.lastname: Su
authors.affiliation: Department of Health Psychology, Chang Jung Christian University, Tainan, Taiwan.
authors.forename: Chu-Mei
authors.initials: CM
authors.lastname: Lan
authors.affiliation: Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Tsung-Han
authors.initials: TH
authors.lastname: Lee
authors.affiliation: Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Shih-Wei
authors.initials: SW
authors.lastname: Hsu
authors.affiliation: Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Neurology, Xiamen Chang Gung Memorial Hospital, Xiamen, China. Electronic address: chlu99@ms44.url.com.tw.
authors.forename: Cheng-Hsien
authors.initials: CH
authors.lastname: Lu
mesh_terms: D000328:Adult; D000367:Age Factors; D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000009:adverse effects*; D005260:Female; D023261:Glasgow Outcome Scale; D006407:Hematoma, Epidural, Cranial / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012887:Skull Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Calvarial skull fracture; Contralateral epidural hematoma; Decompressive craniectomy; Traumatic brain injury