Abstract

ABSTRACT
Background: Traumatic brain injury (TBI) is the leading cause of mortality and disability among young individuals. Epidural hematoma is a neurosurgical emergency which warrants prompt surgical removal. The early mortality rate was 86%, which has reduced now by introduction of imaging modalities, proper resuscitative measures and timely surgical intervention to 5 to 12%

Objective: Assess the socio-demographic characteristics of patients operated for traumatic acute epidural hematoma, assess the surgical outcome and determine factors affecting outcome of these patients.
Methods: It was a prospective cross-sectional study on the outcome of surgically treated patients with traumatic acute epidural hematoma. A total of 132 patients were included in this study which was conducted between February 1st, 2020 and September 30, 2022 at Tikur Anbessa specialized hospital and ALERT trauma center.
Data was collected from interviewing patients or patient’s relatives, patient’s charts and CT scan results using a structured questionnaire. Data was then coded and analyzed using the statistical package for social sciences (SPSS) version 25
Results: In this study 132 patients were included. Majority were referred (76.5%) from a nearby health center where most from the capital city, Addis Ababa, (58.3%). Males were involved in 92.4% of the cases, male to female ratio being 12:1. The mean age at presentation was 30.8 yrs. ranging between 13 & 67 yrs., where majority lie in the 2nd and 3rd decade. The commonest mechanism of injury is assault (59.1%) followed by RTA (25.8%). Vomiting (37.0%) and Altered Sensorium (35.7%) are the two leading symptoms during presentation. The post resuscitation GCS lies in the range of 14-15 (mild) in 48.5% and Majority had normal pupils at examination (89.75%). 98.5% of hematomas are Supratentorial with a tendency to be unilateral in 91.6 %, left side being affected more than the right (49.2 Vs 42.4%). Including hematomas involving two or more regions, parietal region was the most common location (61.4%) followed by equal proportion for frontal & temporal regions (44.7%). The mortality rate is 3% where only 25% is due to intra-op blood loss, the rest (75%) accounted for multi organ dysfunction secondary to sepsis & septic shock. 6.8% of the cases were discharged in vegetative state. Good recovery (GODS 7 &8) was obtained in 75% of the patients & 22% had poor recovery (GODS <6). The factors associated with poor outcome were effacement of basal cisterns (P=0.043), low post-resuscitation GCS (P=0.004), presence of hemiparesis (p<0.001), low O2 saturation (P=0.007) and abnormality in pupillary size and light reaction (P=0.014).
Conclusion: In this study the mortality rate of AEDH is 3% which is much more less from similar previous studies and also from global figures (3-6%). Even though we had 6.8% of cases discharged in a vegetative state, 75% of patients were discharged in good functional recovery.
Factors that were significantly associated with poor outcome were lower post resuscitation GCS at presentation, Presence of effacement of basal cisterns, hemiparesis/plegia, low O2 saturation and pupillary abnormality.