New stereological method for the assessment (prediction) of prognosis in patients with epidural haematoma: the volume fraction of haematoma to the total brain volume

Objective

Epidural haematoma (EH) is a very serious clinical event that is seen in almost 2% of the emergency head trauma patients, and it needs immediate diagnosis and treatment. The relation of EH prognosis with older age, additional intracranial pathologies, Glasgow Coma Scale (GCS) and the duration between the trauma and the surgical attempt has been illustrated in various studies. And the studies regarding the effect of the epidural hematoma volume (EHV) on prognosis are not sufficient.

In this study, different from the previous ones, the ratio of EHV over the total brain volume (TBV) has been estimated with a new method and the relation of this ratio with the prognosis has been investigated.

Method

In this study, 59 EH patients (46 male, 13 female, average age: 21 years) who attended the emergency clinic have been included. Patients with additional intracranial pathologies have been excluded. The age, GCS and the additional system pathology of the patients and the results of their computed cranial tomography (CCT) were recorded. The EHV and TBV ratio was estimated with a stereological method, and the midline shift amounts have also been determined. From the aspect of clinical results, patients have been classified into three groups as complete recovery (43 patients), disability (eight patients) and exitus (eight patients). The ratio of the EHV and TBV of the groups has been compared within the aspects of GCS, age, shift amount and clinical results.

Results

When the ratio of EHV with TBV was compared with clinical results, there was found a statistical sense in the relationship between the groups (P = 0.007). Similarly, there has been found a sense from the statistical aspect between these rates and the shift amount and GCS (P < 0.001, P < 0.001, respectively). However, no difference could be found between the groups in terms of the relationship of EHV ratio over TBV with the age factor (P = 0.2).

Conclusion

The ratio of EHV mathematically calculated with a new method could be an important sign in determining EH prognosis. This method needs to be supported by more clinical and experimental studies in a wider and deeper range.