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Prognostic Factors Trauma and Epidemiologic Related in Surgically Treated Extradural Hematoma

Author(s): Leandro Pelegrini de Almeida, Mateus Carvalho Casarin, Luiz Pedro Williman Rogério, Guilherme Finger, Samir Cezimbra dos Santos, Felipe Lourenzon Schiavo

Background: Extradural hematoma (EDH) represents an important intracranial lesion in patients with traumatic brain injury, since the mortality rate can be high. The outcome from surgical treatment is directly related to patient’s preoperative neurological condition, but there is no specific trauma and epidemiologic prognostic factors that contribute to analyze the patient’s follow-up. 

Objective: Establish prognostics factors based on the characteristics of the trauma that can contribute to the management. 

Methods: Retrospective study performed from January 2005 to January 2016. The inclusion criteria were patients with EDH surgically treated. The exclusion criteria were patients with other types of traumatic brain lesions also with criteria for surgery. Data about the neurological status (GCS), epidemiological and radiological analysis were compared to post-surgical outcome follow-up. 

Results: The sample was composed of 250 patients, commonly males (84.8%) and aged between 10 and 19 years. Motorcycle and car accidents were associated with worst GCS (p=0.001) and outcome (p=0.002). Frontal location was correlated with better GCS and parietal with worst (p=0.0024). GCS was directly correlated with hospitalization time (p=0.003) and outcome (p<0.001). Female subgroup presented better outcome (p=0.019). 

Conclusion: Prognostic conditions must be considered to allow physicians and their team to be prepared to special care and to give better prognostic information to the patient’s relatives. Patients affected by motorcycle and car accidents, with parietal EDH tend to have a worse neurological condition than female patients, with frontal location. The outcome is directly related with GCS and hospitalization time and tends to be worst in a prolonged hospital discharge.

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