Cheung Phoebe S Y, Lam Jenny M Y, Yeung Janice H H, Graham Colin A, Rainer Timothy H
Trauma & Emergency Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR, China.
Injury. 2007 Jan;38(1):76-80. doi: 10.1016/j.injury.2006.08.059. Epub 2006 Nov 13.
Traumatic extradural haematoma (EDH) is a neurosurgical emergency and timely surgical intervention for significant EDH is the gold standard. This study aims to determine the incidence and mortality of consecutive patients with traumatic EDH admitted to the Emergency Department (ED) of Prince of Wales Hospital (PWH), a University Hospital Trauma Centre in Hong Kong.
Retrospective analysis of prospectively collected data for all consecutive trauma cases admitted through the ED during 2001-2004. EDH was diagnosed by CT in all cases. Both primary and delayed onset EDH were included, as were patients with combined EDH and other intracranial lesions (e.g. subdural haematoma). Age, sex, cause of injury, associated intracranial lesions, skull fracture, Glasgow Coma Scale, pupil reactivity, treatment, length of stay and clinical outcome were determined.
Two thousand and two hundred and eight patients were in the trauma registry for 2001-2004. Total 1080 head injured patients; 89 patients had traumatic EDH, mean of 1.9 patients per month. Seventy (79%) patients were male, with a mean age of 37.7 years. Fifty (56%) patients were from road traffic crashes, 27 (30%) sustained falls, 10 (11%) had direct head trauma. On admission, 62 (70%) patients were GCS 13-15, 9 (10%) GCS 9-12 and 18 (20%) GCS 3-8. Sixty-six (74%) patients had a skull fracture. Thirty (34%) patients underwent neurosurgical operation. Overall, nine patients (10%) died; eight patients were GCS<8; five had bilateral fixed and dilated pupils; one had a single fixed and dilated pupil. Four patients died after neurosurgical operation, three of whom had fixed dilated pupils and were GCS 3 prior to surgery. Median length of hospital stay for survivors was 10.4 days.
Survival from traumatic EDH was 90% (80/89) and 91% (73/80) of survivors had a Glasgow Outcome Score of 4 or 5 (good or moderate). The combination of bilateral fixed dilated pupils and GCS 3 suggests severe primary brain injury. Emergency evacuation of intracranial haematomas is unlikely to improve the outcome for these patients. Even in an urban environment with short prehospital times and rapid access to neurosurgery, outcome in patients who are GCS 3 following EDH is likely to be poor.
创伤性硬膜外血肿（EDH）是一种神经外科急症，对大量硬膜外血肿进行及时的手术干预是金标准。本研究旨在确定香港大学医院创伤中心威尔士亲王医院急诊科收治的连续性创伤性硬膜外血肿患者的发病率和死亡率。
回顾性分析2001年至2004年期间通过急诊科收治的所有连续性创伤病例的前瞻性收集数据。所有病例均通过CT诊断为硬膜外血肿。纳入原发性和迟发性硬膜外血肿病例，以及合并硬膜外血肿和其他颅内病变（如硬膜下血肿）的患者。确定患者的年龄、性别、损伤原因、相关颅内病变、颅骨骨折、格拉斯哥昏迷量表评分、瞳孔反应、治疗方法、住院时间和临床结局。
2001年至2004年创伤登记中有2208例患者。共有1080例头部受伤患者；89例患有创伤性硬膜外血肿，平均每月1.9例。70例（79%）为男性患者，平均年龄37.7岁。50例（56%）患者因道路交通事故受伤，27例（30%）因跌倒受伤，10例（11%）因头部直接外伤受伤。入院时，62例（70%）患者格拉斯哥昏迷量表评分为13 - 15分，9例（10%）为9 - 12分，18例（20%）为3 - 8分。66例（74%）患者有颅骨骨折。30例（34%）患者接受了神经外科手术。总体而言，9例（10%）患者死亡；8例患者格拉斯哥昏迷量表评分<8分；5例双侧瞳孔固定散大；1例单侧瞳孔固定散大。4例患者在神经外科手术后死亡，其中3例术前瞳孔固定散大且格拉斯哥昏迷量表评分为3分。幸存者的中位住院时间为10.4天。
创伤性硬膜外血肿患者的生存率为90%（80/89），80名幸存者中有91%（73/80）的格拉斯哥预后评分≥4分或5分（良好或中等）。双侧瞳孔固定散大与格拉斯哥昏迷量表评分为3分同时出现提示严重的原发性脑损伤。对这些患者进行颅内血肿的紧急清除不太可能改善其预后。即使在院前时间短且能迅速获得神经外科治疗的城市环境中，硬膜外血肿后格拉斯哥昏迷量表评分为3分的患者预后可能也很差。
