title: Outcomes in Trauma Patients with Isolated Epidural Hemorrhage: A Single-Institution Retrospective Cohort Study.
abstract: The type, location, and size of intracranial hemorrhage are known to be associated with variable outcomes in patients with traumatic brain injury (TBI). The aim of our study was to assess the outcomes in patients with isolated epidural hemorrhage (EDH) based on the location of EDH. We performed a 3-year (2010-2012) retrospective chart review of the patients with TBI in our level 1 trauma center. Patients with an isolated EDH on initial head CT scan were included. Patients were divided into four groups based on the location of EDH: frontal, parietal, temporal, and occipital. Differences in demographics and outcomes between the four groups were assessed. Outcome measures were progression on repeat head CT and neurosurgical intervention (NI). A total of 76 patients were included in this study. The mean age was 20.6 ± 15.2 years, 68.4 per cent were male, median Glasgow Coma Scale (GCS) score 15 (13-15), and median head Abbreviated Injury Scale score was 3 (2-4). About 32.9 per cent patients (n = 25) had frontal EDH, 26.3 per cent (n = 20) had temporal EDH, 10.5 per cent (n = 8) had occipital EDH, while the remaining 30.3 per cent (n = 23) had parietal EDH. The overall progression rate was 21.1 per cent (n = 12) and NI rate was 29 per cent (n = 22). There was no difference in the outcome of patients based on location of EDH. Patients with NI had a longer hospital length of stay (P = 0.02) and longer intensive care unit length of stay (P = 0.05). The incidence of isolated EDH is low in patients with blunt TBI. Patients with isolated EDH undergoing NI have longer hospital stays compared to patients without NI. Further investigation is warranted to identify factors associated with need for NI and adverse outcomes in the cohort of patients with isolated EDH.
authors.affiliation: Division of Trauma, Department of Surgery, University of Arizona, Tucson, Arizona, USA.
authors.forename: Bardiya
authors.initials: B
authors.lastname: Zangbar
authors.forename: Bradley
authors.initials: B
authors.lastname: Serack
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.forename: Viraj
authors.initials: V
authors.lastname: Pandit
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.forename: Ansab A
authors.initials: AA
authors.lastname: Haider
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Tang
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D001930:Brain Injuries / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D018450:Disease Progression; D005260:Female; D015600:Glasgow Coma Scale; D006407:Hematoma, Epidural, Cranial / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000150:complications; D055815:Young Adult