Extradural hematoma management: A case-control study with historical controls reassessing the 'zero mortality' goal

Area of Science:

• Neurosurgery
• Trauma Care Systems
• Public Health

Background:

• Extradural hematoma (EDH) is a significant cause of mortality after traumatic brain injury (TBI).
• Fatality rates for EDH have declined over time.
• A
• zero mortality
• goal has long been pursued for surgically treated EDH.

Purpose of the Study:

• To evaluate the impact of a four-decade evolution in a regional trauma and neurosurgical care system.
• To determine if the "zero mortality" goal has been achieved for surgically treated EDH.
• To analyze changes in patient demographics, injury causes, and treatment timelines.

Main Methods:

• Retrospective review of surgically treated EDH patients from 2011-2021.
• Comparison with a historical cohort from the early 1980s.
• Case-control design analyzing demographic, clinical, and radiological data.

Main Results:

• In-hospital mortality for EDH decreased from 4.7% in the 1980s to 2.4% in 2011-2021.
• Contemporary patients were older (41-61 vs. 11-20 years), with falls as the leading cause (55% vs. 50% road traffic accidents).
• Direct presentations (65% vs. 33%) and arrival within 6 hours (96% vs. 65%) significantly increased, though surgery within 6 hours was achieved in 68% of contemporary cases.

Conclusions:

• System-wide improvements have significantly reduced EDH mortality, but the "zero mortality" target is not yet met.
• Delays in referral and triage remain critical challenges, especially for complex or rapidly progressing cases.
• Further optimization of trauma and neurosurgical care pathways is necessary to approach the "zero mortality" goal for EDH.