Traumatic acute epidural hematoma: unrecognized high lethality in comatose patients

A series of 51 comatose patients suffering traumatic epidural hematoma after closed head injury is reviewed. This prospective series was accumulated from the National Pilot Traumatic Coma Data Bank during a 2-year period and represents 9% of all patients entered into the Data Bank. The overall mortality was 41%, with 4% remaining in the vegetative state. Fifty per cent of these patients, all of whom were in coma, also had an associated intracerebral contusion. There was no difference in outcome with regard to sex, mode of injury, or the presence or absence of contusion or shift on the computed tomographic (CT) scan. The motor score immediately before operation was the most powerful preoperative predictor of outcome. Sixty-seven per cent or two-thirds of the patients with a motor score of 4, 5, or 6 on the Glasgow coma scale had a satisfactory outcome at last follow-up examination. In contrast, in patients with a motor score of 3 or less, two-thirds either died or remained in a vegetative state. The acute traumatic epidural hematoma is often lethal in the comatose patient. We recommend early evacuation of epidural hematomas, i.e., when they are first noted on the CT scan, rather than waiting for clinical motor deterioration.