Extradural hematoma at the Kinshasa University Hospital: clinico-scannographic profile and post-treatment evolution

Abstract

Context and objective. The advent of two-wheeled vehicles has led to an increase in head injuries in Kinshasa. The objectives of the study were to describe the clinical profile of consequent extradural haematomas (EDH) and to investigate the determinants of post-therapeutic outcome. Methods. This was an analytic series of EDH cases followed up at Kinshasa University Hospital between January 2002 and December 2018. Variables of interest included clinical and therapeutic data as well as therapeutic course. Chi-square tests and linear regression were used, to compare proportions and establish the relationship between variables, respectively. Results. One hundred and two patient records (mean age 28.3 ± 15.2 years, male sex 92%) with EDH were compiled.  Traffic accidents were the main etiology (70.6%). Focal and lateral signs were observed in 57.8% and 46.1% of cases, respectively. Head injuries were considered mild in 61.8% of cases, and severe in 18.6%. The median diagnosis time was 3 days, with 59% of associated intracerebral lesions and 75.5% of cranial fractures. Median operating time was 2 days. The mortality rate was 14.7%, and the median hospital stay was 21 days (1 and 119 days). Mortality was related to Glasgow coma score on admission (p<0.0001), delayed management (p=0.02), polytrauma context (p=0.021), existence of associated brain lesions (p=0.018), anisocoria and tight miosis (<0.0001). There was an association between hematoma volume, location (y=0.0026x+29, 713 / R2=3E-05) and time to management (y=1.1852x + 44.396/R2=0.0522).  Conclusion. Diagnostic and therapeutic delays in EDH are long, justifying the high mortality, especially in cases of polytrauma and pupillary anomaly.

Received: February 3^rd, 2024

Accepted: June 28^th, 2024

https://dx.doi.org/10.4314/aamed.v17i4.4