Improving mortality after extradural haematoma in England and Wales

Head injury is an important cause of death and disability in young people, with 1.4 million presentations each year in the UK.( 1 ) Extradural haematoma (EDH) is a potentially fatal head injury, which is easily remedied surgically. Several factors influence the mortality of EDH. The mortality of isolated EDH ranges from 1.2 to 33%.( 12 , 16 , 19 , 28 ) EDH outcome within the UK has not been recently described.

The Trauma Audit and Research Network (TARN) database was used to collate data on patients in England and Wales, with 'isolated' EDH between 1997 and 2003. Age, gender, GCS at 1(st) emergency department (ED), haematoma size, presence of a skull fracture, outcome (alive or dead) and injury-to-operation time were required. Where this time was unavailable, an estimation could be made using another time collected for the patient. Data coordinators at several hospitals were contacted in order to collect extra information missing from the database. The mortality for this group was then calculated and comparisons between this and previous series were made.

A total of four-hundred and eighty four (484) patients with isolated EDH were identified. One-hundred and ninety-seven (197) patients were operated on in England and Wales in this TARN dataset, between 1997 and 2003 for 'isolated' EDH. The mortality rate for this operative series was 2% (4 patients) (95% CI 0.1-4%). The non-operative mortality rate was 3% (95% CI 0.9-5.0%).

This study has found a low EDH operative mortality rate of 2%. This is lower than that of previous studies on isolated EDH in the UK. This is likely to be valid as TARN is the largest European trauma registry, although we acknowledge that this first EDH sample derived from UK EDs may represent a selected series.