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Manejo del hematoma extradural: un estudio de casos y controles con controles históricos que reevalúa el objetivo de
N Marchesini1,2, L Rossi3, E Saiu3
1Leiden University Medical Center (LUMC), Leiden, the Netherlands.
Brain & spine
|February 23, 2026
Resumen
Las mejoras en la atención del trauma han reducido la mortalidad de los pacientes con hematoma extradural (HED), pero el objetivo de "mortalidad cero" sigue siendo esquivo. Los retrasos en la atención todavía presentan desafíos para el tratamiento de pacientes con traumatismo craneoencefálico (TCE) con HED.
Área de la Ciencia:
- Neurocirugía
- Sistemas de atención de traumatología
- Salud pública
Sus antecedentes:
- El hematoma extradural (HED) es una causa importante de mortalidad después de un traumatismo craneoencefálico (TCE).
- Las tasas de letalidad del HED han disminuido con el tiempo.
- Se ha perseguido durante mucho tiempo un objetivo de "mortalidad cero" para el HED tratado quirúrgicamente.
Objetivo del estudio:
- Evaluar el impacto de una evolución de cuatro décadas en un sistema regional de atención de trauma y neurocirugía.
- Determinar si se ha logrado el objetivo de "mortalidad cero" para el HED tratado quirúrgicamente.
- Analizar los cambios en la demografía de los pacientes, las causas de las lesiones y los plazos de tratamiento.
Principales métodos:
- Revisión retrospectiva de pacientes con HED tratados quirúrgicamente de 2011 a 2021.
- Comparación con una cohorte histórica de principios de la década de 1980.
- Diseño de casos y controles que analiza datos demográficos, clínicos y radiológicos.
Principales resultados:
- La mortalidad intrahospitalaria por HED disminuyó del 4,7% en la década de 1980 al 2,4% en 2011-2021.
- Los pacientes contemporáneos eran mayores (41-61 frente a 11-20 años), y las caídas eran la causa principal (55% frente al 50% de los accidentes de tráfico).
- Las presentaciones directas (65% frente al 33%) y la llegada en menos de 6 horas (96% frente al 65%) aumentaron significativamente, aunque la cirugía en menos de 6 horas se logró en el 68% de los casos contemporáneos.
Conclusiones:
- Las mejoras en todo el sistema han reducido significativamente la mortalidad por HED, pero el objetivo de "mortalidad cero" aún no se ha alcanzado.
- Los retrasos en la derivación y el triaje siguen siendo desafíos críticos, especialmente para casos complejos o de progresión rápida.
- Es necesaria una mayor optimización de las vías de atención de trauma y neurocirugía para acercarse al objetivo de "mortalidad cero" para el HED.
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