Patient Profile and Outcomes of Traumatic Extradural Haematomas as Seen at The Nakuru Level Five Hospital in Kenya

Abstract

Background: An extradural haematoma (EDH) also referred to as epidural haematoma is a collection of blood between the skull and the dura. Extradural haematomas are present in 1-2% of all head injury patients. In those who present in coma, extradural haematomas are present in 10% of them. Mortality rates have been reported to range from 5-43% in different regions of the world. Mortality is reportedly nil in patients who present without coma and 20% for those who present comatosed. Methods: A prospective cross sectional descriptive study of patients diagnosed with extradural haematoma by CT scan conducted at the Nakuru level five hospital between 1st January 2015 and 30th November 2015. Descriptive patient demographic data, clinical presentation data, investigations, surgical treatments offered, length of hospital stay and outcomes were captured using a questionnaire. Results: A total of 32 patients with extradural haematoma were recruited into the study. There was a male preponderance that accounted for 96.8% of patients. Their ages ranged from 5 to 64 years with a mean age of 30.75 years (+ 13.6) and. The commonest cause of injury was assault at 31.3% of all head injury patients followed by motorcycle related accidents at 28.1%. There were 34.4% mildly injured patients, 43.8% moderate and 21.9% of patients severely head injured. There were 8 deaths (25%) of the patients and 59.4% of the patients had good recovery. Low GCS, rhinorhoea, otorhoea, presence of an intracerebral haematoma, admission to the ICU, convulsions and loss of consciousness were associated with poor outcome.( p=0.00, 0.001, 0.022, 0.002, 0.009, 0.000, and 0.044 respectively). Conclusion: The extradural haematoma patient is mostly a young male. The commonest cause of extradural haematoma is assault/violence related followed by motorcycle accidents. There is an important co relationship between Glasgow coma score and outcome. Likewise Convulsions, loss of consciousness at any time after injury, otorhoea , rhinorhoea and presence of associated injuries worsened outcomes in this subset of extradural haematoma patients.

Key words: Profile, outcomes, traumatic, extradural, haematomas