[Prognosis of epidural hematoma: is emergency burr hole trepanation in craniocerebral trauma still justified today?].

We made a retrospective study of the records of 80 patients with epidural haematoma, to investigate whether delay between injury and surgery and neurological status upon admission affect outcome after 3-6 months. Outcome was classified on a four-grade scale, grade 1 meaning full recovery and grade 4, death. Overall mortality was 13%. Patients operated on within 7 h after injury made a full recovery in 52%, and mortality in this group was 6%. Patients operated on between 7 h and 14 h after injury made a full recovery in 20%; mortality was 16%. Among the patients who were not comatose on admission a good outcome was achieved in 55% and mortality was 3%. The outcome in patients who were comatose on admission was rated grade 1 in 15% and grade 4 in 25%. The proportion of comatose patients and the mortality were higher in patients transferred from general hospitals. Textbook signs of epidural haematoma are not reliable aids to diagnosis and localization; for example a lucid interval occurred in only 58% of our patients. It is concluded that emergency burr hole trepanation might improve the outcome in patients showing signs of brain stem dysfunction after head injury, but prior computed tomography is necessary to guide such an intervention at the district hospital level.