Traumatic extradural hematoma - role of non-surgical management and reasons for conversion

Abstract

Background: To study the role of conservative management and various reasons for conversion to surgical intervention in traumatic extradural hematoma (EDH). Setting: Government Medical College Jammu. Materials and methods: One hundred-twenty trauma patients diagnosed as extradural hematoma on CT scan were managed during 1 year period. Outcomes: Role of conservative management and various reasons for conversion to surgical intervention were studied. Results: Out of these 120 patients admitted 67 were managed conservatively, 53 cases were operated upon. 31 were operated upon immediately and 22 were operated upon as delayed. There was 1 death and 4 had poor outcome in this group of patients. Conclusion: It is stressed that small size <10 ml, GCS >12 and locations other than temporal area are the criteria for conservative management. Twenty-two patients out of 89 were needed to be treated surgically during the course of conservative management due to neurodeterioration, increase in size of hematoma on CT, bradycardia, hemiparesis, pupillary abnormalities, delay in referral and only 18% had poor outcome. A strict vigilance is to be kept for clinical deterioration and various reasons mentioned above are to be kept in mind and patients should be subjected to repeated CT scan. Early diagnosis and immediate surgical intervention had good outcome, which shows the fruitful results of early diagnosis and intervention. © Association of Surgeons of India 2010.