Radmard Mahla, Miller Luke, Tafazolimoghadam Armin, Hadidchi Shahram, Hsu Joyce, Moon Jee, Speer Samuel, Yousem David M, Azzi Caline
From the Russell H. Morgan Department of Radiology and Radiological Science (M.R., L.M., S.H., J.H., J.M., S.S., D.M.Y., C.A.), Johns Hopkins Medical Institution, Baltimore, Maryland.
Tehran University of Medical Sciences, Johns Hopkins Medical Institution (A.T.), Baltimore, Maryland.
AJNR Am J Neuroradiol. 2025 Jul 24. doi: 10.3174/ajnr.A8832.
The use of head CT in trauma settings has increased significantly, driven by the need to detect and monitor intracranial hemorrhages. Among intracranial hemorrhage subtypes, epidural hematomas (EDHs) are relatively uncommon but require careful evaluation due to their potential for expansion and the need for surgical intervention. This study aimed to identify risk factors for initial EDH size, subsequent enlargement, and the need for surgical intervention to guide imaging and treatment strategies.
We conducted a retrospective review of 32,401 noncontrast head CT reports from 2 trauma centers (The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center) between 2018 and 2024. Patients with EDHs were identified using a structured search of radiology reports. Clinical, demographic, and imaging characteristics were analyzed to assess the predictors of EDH enlargement and the need for surgery. Statistical analyses included the χ or Fisher exact test, Mann-Whitney test, Kruskal-Wallis H test, and logistic regression analysis.
Among 91 cases of EDH, a larger initial EDH size was associated with arterial bleeding sources, mixed attenuation, and the spot sign. These same factors, plus a midline shift, predicted the need for initial surgery. No clinical features or comorbidities predicted a larger EDH. Follow-up imaging revealed EDH enlargement in 25/89 cases (28.1%), with SAH as the only significant predictor (OR = 2.60; 95% CI, 1.00-6.77; = .05). The scans that demonstrated EDH enlargement were performed after a mean of 6.6 (SD 3.3) hours. Ultimately, 25/91 (27.5%) EDHs required surgical intervention; only EDH enlargement was predictive of the need for follow-up surgery after initial observation.
The presence of concurrent SAH was the strongest predictor of EDH enlargement, and radiologists should recommend short-term monitoring of patients with EDH and SAH. Repeat CT at 6-13 hours will detect nearly all cases of EDH enlargement, which may lead to subsequent surgery. Initial large size, midline shift, arterial sources of bleeds, and active bleeding imaging findings correlated with an early surgical intervention. Future multicenter studies are needed to refine risk stratification and optimize imaging follow-up to balance patient safety and health care resource use.
在创伤情况下，由于检测和监测颅内出血的需求，头部CT的使用显著增加。在颅内出血亚型中，硬膜外血肿（EDH）相对少见，但因其有扩大的可能性及需要手术干预，故需仔细评估。本研究旨在确定初始EDH大小、后续扩大以及手术干预需求的危险因素，以指导影像学和治疗策略。
我们对2018年至2024年间来自2个创伤中心（约翰霍普金斯医院和约翰霍普金斯湾景医疗中心）的32401份非增强头部CT报告进行了回顾性研究。通过对放射学报告进行结构化搜索来识别患有EDH的患者。分析临床、人口统计学和影像学特征，以评估EDH扩大和手术需求的预测因素。统计分析包括χ²检验或Fisher精确检验、Mann-Whitney检验、Kruskal-Wallis H检验和逻辑回归分析。
在91例EDH病例中，初始EDH较大与动脉出血来源、混合密度及斑点征相关。这些相同因素，加上中线移位，预测了初始手术的需求。没有临床特征或合并症可预测EDH更大。随访影像学显示，89例中有25例（28.1%）EDH扩大，蛛网膜下腔出血（SAH）是唯一显著的预测因素（OR = 2.60；95%CI，1.00 - 6.77；P = 0.05）。显示EDH扩大的扫描平均在6.6（标准差3.3）小时后进行。最终，91例中有25例（27.5%）EDH需要手术干预；只有EDH扩大可预测初始观察后需要后续手术。
并发SAH是EDH扩大的最强预测因素，放射科医生应建议对患有EDH和SAH的患者进行短期监测。在6 - 13小时重复CT将检测到几乎所有EDH扩大的病例，这可能导致后续手术。初始大尺寸、中线移位、动脉出血来源及活动性出血影像学表现与早期手术干预相关。未来需要多中心研究来完善风险分层并优化影像学随访，以平衡患者安全和医疗资源利用。
