Acute traumatic epidural and subdural haematomas: a clinical study

A clinical study of patients with head injury who develop acute epidural and subdural haematomas has been done. Clinical monitoring of patients with head injury to detect development of intracranial haematoma is vital. This study sets to identify clinical symptoms and signs which influenced decisions towards further observations, referal to bigger centres investigation for haematoma or operation in patients with head injury who developed acute intracranial haematomas. It further looks into the incidence and pattern of skull fractures among these patients and the incidence of delayed and recurrent haematomas. In addition the factors which influence the initial mortality after surgery in these patients have been investigated. Clinical records of patients with acute traumatic epidural and subdural haematoma who were managed at the Neurological centre Nijmegen, the Netherlands between 1975 - 1985 were studied. Information was extracted using questionnaire. There were 134 patients of whom 71 had epidural, 58 subdural and 5 a combination of epidural and subdural haematomas. On admission 53.8% of EDH and 69% of ASDH patients had signs or symptoms suggestive of haematoma and were initially investigated. The rest i. e 46.5% of patients with EDH and 31% of ASDH patients were initially observed. The main clinical signs which influenced further investigation in the observed group of patients were deteriorating level of consciousness, pupillary dilatation anal hemiparesis. 73.2% of EDH patients and 50% of ASDH patient had skull fractures, 5.2% of the 134 patients developed delayed haematoma while 3% of all patients developed reaccu- mulation of haematoma. Factors which influenced the initial mortality after surgery were age of patient, type of haematoma, level of consciousness at time of admission and presence of contusion at operation. Mere presence of skull fracture did not significantly influence the mortality.