Harvard Medical School, Boston, MA, USA.
Program in Global Surgery and Social Change, Harvard University, Boston, MA, USA.
Clin Neurol Neurosurg. 2022 Aug;219:107313. doi: 10.1016/j.clineuro.2022.107313. Epub 2022 Jun 6.
Approximately 69 million people suffer from traumatic brain injury (TBI) annually. Patients with isolated epidural hematomas (EDH) with access to timely surgical intervention often sustain favorable outcomes. Efforts to ensure safe, timely, and affordable access to EDH treatment may offer tremendous benefits.
A comprehensive literature search was conducted. A random-effects model was used to pool the outcomes. Studies were further categorized into groups by World Bank Income classification: high-income countries (HICs) and low- and middle-income countries (LMICs).
Forty-nine studies were included, including 36 from HICs, 12 from LMICs, and 1 from HIC / LMIC. Incidence of EDH amongst TBI patients 8.2 % (95 % CI: 5.9,11.2), including 9.2 % (95 %CI 6.4,13.2) in HICs and 5.8 % (95 % CI: 3.1,10.7) in LMICs (p = 0.20). The overall percent male was 73.7 % and 47.4 % were caused by road traffic accidents. Operative rate was 76.0 % (95 %CI: 67.9,82.6), with a numerically lower rate of 74.2 % (95 %CI: 64.0,81.8) in HICs than in LMICs 82.9 % (95 %CI: 65.4,92.5) (p = 0.33). This decreased to 55.5 % after adjustment for small study effect. The non-operative mortality (5.3 %, 95 %CI: 2.2,12.3) was lower than the operative mortality (8.3 %, 95 %CI: 4.6,14.6), with slightly higher rates in HICs than LMICs. This relationship remained after adjustment for small study effect, with 9.3 % operative mortality compared to 6.9 % non-operative mortality.
With an overall EDH incidence of 8.2 % and an operative rate of 55.5 %, 3.1 million people worldwide require surgery for traumatic EDH every year, most of whom are in prime working age. Given the favorable prognosis with treatment, traumatic EDH is a strong investment for neurosurgical capacity building.
每年约有 6900 万人患有创伤性脑损伤（TBI）。对于能够及时接受手术干预的单纯硬膜外血肿（EDH）患者，通常可获得良好的预后。努力确保安全、及时和负担得起的 EDH 治疗机会可能会带来巨大的益处。
进行了全面的文献检索。使用随机效应模型对结果进行汇总。根据世界银行收入分类，将研究进一步分为高收入国家（HICs）和中低收入国家（LMICs）组：高收入国家（HICs）和中低收入国家（LMICs）。
共纳入 49 项研究，其中 36 项来自 HICs，12 项来自 LMICs，1 项来自 HIC/LMIC。TBI 患者中 EDH 的发生率为 8.2%（95%CI：5.9，11.2），HICs 中为 9.2%（95%CI：6.4，13.2），LMICs 中为 5.8%（95%CI：3.1，10.7）（p=0.20）。总体男性比例为 73.7%，47.4%由道路交通伤引起。手术率为 76.0%（95%CI：67.9，82.6），HICs 中手术率略低于 LMICs 的 82.9%（95%CI：65.4，92.5）（74.2%（95%CI：64.0，81.8）（p=0.33）。调整小样本研究效应后，这一比例降至 55.5%。非手术死亡率（5.3%，95%CI：2.2，12.3）低于手术死亡率（8.3%，95%CI：4.6，14.6），HICs 略高于 LMICs。在调整小样本研究效应后，这一关系仍然存在，手术死亡率为 9.3%，而非手术死亡率为 6.9%。
全球每年有 310 万人因创伤性 EDH 需要手术治疗，总体 EDH 发病率为 8.2%，手术率为 55.5%，其中大多数人处于最佳工作年龄。鉴于治疗后预后良好，创伤性 EDH 是神经外科学能力建设的有力投资。
