FREQUENCY OF ENLARGEMENT OF EXTRADURAL HEMATOMA IN REPEAT CT SCAN IN CONSERVATIVELY MANAGED TRAUMA PATIENTS

M SAQIB; F AZAM; M SALEEM; N UDDIN; S ALI; S SHAFIQUE

doi:10.54112/pjicm.v5i02.149

Authors

M SAQIB Department of Neurosurgery, Lady Reading Hospital -MTI Peshawar, Pakistan
F AZAM Department of Neurosurgery, Lady Reading Hospital -MTI Peshawar, Pakistan
M SALEEM Department of Neurosurgery, Lady Reading Hospital -MTI Peshawar, Pakistan
N UDDIN Department of Neurosurgery, Lady Reading Hospital -MTI Peshawar, Pakistan
S ALI Department of Neurosurgery, Lady Reading Hospital -MTI Peshawar, Pakistan
S SHAFIQUE Department of Neurosurgery, Lady Reading Hospital -MTI Peshawar, Pakistan

DOI:

https://doi.org/10.54112/pjicm.v5i02.149

Keywords:

Extradural Hematoma, Conservative Management, Computed Tomography, Trauma, Enlargement

Abstract

Background: Extradural hematoma (EDH) is a potentially life-threatening complication of head trauma. While surgical intervention is indicated for large or rapidly expanding hematomas, many cases are initially managed conservatively. Repeat CT imaging is crucial for monitoring progression; however, the frequency of enlargement in this setting is variably reported. Objective: To determine the frequency of enlargement of extradural hematoma on repeat CT scans in patients with conservatively managed head trauma. Study Design: Descriptive cross-sectional study. Setting: Department of Neurosurgery, Lady Reading Hospital, Peshawar, Pakistan. Duration of Study: 25-November-2024 to 25-May-2025. Methods: A total of 126 patients aged 5–60 years presenting within 24 hours of head trauma were enrolled. The inclusion criteria were a Glasgow Coma Scale (GCS) score greater than 12 and the absence of concurrent surgical pathologies. All patients were managed conservatively and underwent repeat CT scans 48 hours later. EDH enlargement was defined as a biconvex hyperdensity with thickness >10 mm, midline shift >6 mm, or volume >30 ml. Data were analyzed using SPSS 26. Results: The mean age was 19.60 ± 13.74 years, with a male predominance (77.0%). Road traffic accidents were the most common cause of injury (53.2%), followed by falls from height (34.1%) and assault (12.7%). Enlargement of EDH was observed in 25 patients, yielding a frequency of 19.8%. Conclusion: Nearly one-fifth of conservatively managed EDH cases showed enlargement on repeat CT scans. Routine follow-up imaging at 48 hours is recommended, especially in high-risk patients, to ensure timely surgical intervention and improve outcomes.

References

Arrese I, Lobato RD, Gomez PA, Nunez AP. Hyperacute epidural haematoma isodense with the brain on computed tomography. Acta Neurochir (Wien). 2004;146(2):193-4. https://doi.org/10.1007/s00701-003-0171-6

Basamh M, Robert A, Lamoureux J, Saluja RS, Marcoux J. Epidural hematoma treated conservatively: when to expect the worst. Can J Neurol Sci. 2016;43(1):74-81. https://doi.org/10.1017/cjn.2015.232

Bejjani GK, Donahue DJ, Rusin J, Broemeling LD. Radiological and clinical criteria for the management of epidural hematomas in children. Pediatr Neurosurg. 1996;25(6):302-8. https://doi.org/10.1159/000121144

Daoud SS, Jamous MA, Al Barbarawi MM, Jarrar S, Jaradat A, Aljabali AS, et al. Operative versus non-operative management of posterior fossa epidural hematoma: a systematic review and meta-analysis. Neurochirurgie. 2024;70(5):101578. https://doi.org/10.1016/j.neuchi.2024.101578

Gok H, Celik SE, Yangi K, Yavuz AY, Percinoglu G, Unlu NU, et al. Management of epidural hematomas in pediatric and adult population: a hospital-based retrospective study. World Neurosurg. 2023;177:e686-92. https://doi.org/10.1016/j.wneu.2023.06.123

Sharafat S, Azam F, Khan Z. Posterior fossa epidural hematoma: a 6-year management experience. Pak J Med Sci. 2023;39(1):253. https://doi.org/10.12669/pjms.39.1.6056

Tamburrelli FC, Meluzio MC, Masci G, Perna A, Burrofato A, Proietti L. Etiopathogenesis of traumatic spinal epidural hematoma. Neurospine. 2018;15(1):101-7. https://doi.org/10.14245/ns.1836068.034

Fernández-Abinader JA, González-Colón K, Feliciano CE, Mosquera-Soler AM. Traumatic brain injury profile of an elderly population in Puerto Rico. P R Health Sci J. 2017;36(4):237-9.

Scafa AK, Jiang T, Pescatori L, Corsini M, Piccirilli M. Association between spontaneous intracranial epidural hematoma and craniofacial infections: a systematic literature review. Surg Neurol Int. 2023;14:57. https://doi.org/10.25259/SNI_1068_2022

Bisen YT, Korde P, Dighe O, Iratwar S, Bisen G. Decompressive craniectomy in the management of low Glasgow coma score patients with extradural hematoma: a review of literature and guidelines. Cureus. 2023;15(1):e33790. https://doi.org/10.7759/cureus.33790

Kim C, Lee S, Kim Y, Sung S, Son D, Song G. Predictors of hematoma enlargement in patients with spontaneous intracerebral hemorrhage treated with rapid administration of antifibrinolytic agents and strict conservative management. Korean J Neurotrauma. 2019;15(2):126-8. https://doi.org/10.13004/kjnt.2019.15.e23

Mezue WC, Ndubuisi CA, Chikani MC, Achebe DS, Ohaegbulam SC. Traumatic extradural hematoma in Enugu, Nigeria. Niger J Surg. 2012;18(2):80-4. https://doi.org/10.4103/1117-6806.103111

Sullivan TP, Jarvik JG, Cohen WA. Follow-up of conservatively managed epidural hematomas: implications for the timing of repeat CT scans. AJNR Am J Neuroradiol. 1999;20(1):107-13.

Metwally MM, Abdel-Bary TH, Abd El Aziz MR, Abaza HA. Evaluation of conservative management of traumatic extradural hemorrhage and role of surgery during follow-up. Egypt J Hosp Med. 2024;96(1):2871-6.

Zwayed ARH, Lucke-Wold B. Conservative management of extradural hematoma: a report of sixty-two cases. Neurol Clin Neurosci. 2018;2(2):5-9.

Aurangzeb A, Afridi EAK, Khan SA, Muhammad G, Ihsan A, Hussain I, et al. Frequency of extradural haematoma in patients with linear skull fracture. J Ayub Med Coll Abbottabad. 2015;27(2):314-7.