eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Epidural Hematoma: Follow-up

Author: Daniel D Price, MD, Director of Ultrasound Fellowship, Department of Emergency Medicine, Highland General Hospital, Alameda County Medical Center
Coauthor(s): Sharon R Wilson, MD, Assistant Professor of Emergency Medicine, Department of Emergency Medicine, University of California at Davis Medical Center
Contributor Information and Disclosures

Updated: Nov 18, 2009

Follow-up

Further Inpatient Care

  • Transfer to operating room (OR) for epidural hematoma (EDH) evacuation and repair.
  • Admit to neurosurgical ICU after surgery or directly for monitoring. This will likely include ICP, partial pressure oxygen (PO2), or other intracranial monitoring devices.
  • Repeat CT scan in the event of clinical deterioration.

Transfer

  • Transfer to hospital with a CT scanner and neurosurgeon.
  • Consider air transport if a trauma center is distant; timely decompression is critical for a good outcome.

Deterrence/Prevention

  • Encourage use of seat belts and car seats.
  • Advocate helmets for bicycling, skateboarding, snowboarding, rollerblading, and horse and motorcycle riding.

Complications

  • Neurobehavioral changes: Postconcussive syndrome can last hours to months (see Postconcussive Syndrome).
  • Vegetative state
  • Death

Prognosis

  • Mortality rates are essentially nil for patients not in coma preoperatively and approximately 10% for obtunded patients and 20% for patients in deep coma.
  • If treated early, prognosis usually is excellent, because the underlying brain injury generally is limited.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider diagnosis, especially in a conscious patient with normal pupils
  • Failure to transfer expeditiously to a trauma center with a neurosurgeon (air medical transport may be warranted)
  • Failure to diagnose EDH in a patient with altered mental status (instead naming alcohol or another intoxicant as the cause)
  • Failure to perform frequent routine neurologic checks in patients who are being observed rather than sent for CT scan

Special Concerns

  • Pediatric patients
    • Pediatric patients may not fracture the skull.
    • Pediatric patients have lower mortality rates, except in infants.
    • Guidelines for managing pediatric traumatic brain injury were published in 2003.10 They reflect adult guidelines with the exceptions of age-appropriate blood pressures and cerebral perfusion pressure, and endorsement of the use of hypertonic saline for control of increased ICP.
  • Geriatric patients
    • EDH is more likely to occur with a fall.
    • Overall, EDH is much less common in older patients.
    • Subdural hematoma (SDH) is more common than EDH in elderly patients with intracranial hematoma. Brain atrophy stretches bridging veins.
    • Elderly patients have higher mortality rates.
 


More on Epidural Hematoma

Overview: Epidural Hematoma
Differential Diagnoses & Workup: Epidural Hematoma
Treatment & Medication: Epidural Hematoma
Follow-up: Epidural Hematoma
Multimedia: Epidural Hematoma
References
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References

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  2. [Guideline] Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons; Joint Section on Neurotrauma and Critical Care, AANS/CNS. Guidelines for the management of severe traumatic brain injury. I. Blood pressure and oxygenation. J Neurotrauma. 2007;24 Suppl 1:S7-13. [Medline]. [Full Text].

  3. [Guideline] Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons; Joint Section on Neurotrauma and Critical Care, AANS/CNS. Guidelines for the management of severe traumatic brain injury. II. Hyperosmolar therapy. J Neurotrauma. 2007;24 Suppl 1:S14-20. [Medline]. [Full Text].

  4. [Guideline] Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons; Joint Section on Neurotrauma and Critical Care, AANS/CNS. Guidelines for the management of severe traumatic brain injury. IV. Infection prophylaxis. J Neurotrauma. 2007;24 Suppl 1:S26-31. [Medline]. [Full Text].

  5. [Guideline] Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons; Joint Section on Neurotrauma and Critical Care, AANS/CNS. Guidelines for the management of severe traumatic brain injury. XI. Anesthetics, analgesics, and sedatives. J Neurotrauma. 2007;24 Suppl 1:S71-6. [Medline]. [Full Text].

  6. [Guideline] Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons; Joint Section on Neurotrauma and Critical Care, AANS/CNS. Guidelines for the management of severe traumatic brain injury. XIII. Antiseizure prophylaxis. J Neurotrauma. 2007;24 Suppl 1:S83-6. [Medline]. [Full Text].

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  9. [Guideline] Bratton SL, Chestnut RM, Ghajar J, et al. Guidelines for the management of severe traumatic brain injury. IX. Cerebral perfusion thresholds. J Neurotrauma. 2007;24 Suppl 1:S59-64. [Medline]. [Full Text].

  10. [Guideline] Adelson PD, Bratton SL, Carney NA, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 1: Introduction. Pediatr Crit Care Med. Jul 2003;4(3 Suppl):S2-4. [Medline].

  11. [Guideline] American Association of Neurological Surgeons. Guidelines for the management of severe head injury. Congress of Neurological Surgeons:1995.

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  18. Schmidek HH, Sweet WH. Operative Neurosurgical Techniques: Indications, Methods, and Results. 4th ed. W B Saunders Co; 2000.

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Further Reading

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Keywords

epidural hematoma, epidural hematoma causes, epidural hematoma symptoms, epidural hematoma treatment, traumatic brain injury, EDH, head injury, extradural hemorrhage, blood between the skull and dura mater

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Contributor Information and Disclosures

Author

Daniel D Price, MD, Director of Ultrasound Fellowship, Department of Emergency Medicine, Highland General Hospital, Alameda County Medical Center
Daniel D Price, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Sharon R Wilson, MD, Assistant Professor of Emergency Medicine, Department of Emergency Medicine, University of California at Davis Medical Center
Sharon R Wilson, MD is a member of the following medical societies: American Association of University Women, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Robert M McNamara, MD, FAAEM, Chair and Professor, Department of Emergency Medicine, Temple University School of Medicine
Robert M McNamara, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Pennsylvania Medical Society, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eric L Legome, MD, Chair, Department of Emergency Medicine, St Vincent's Hospital Manhattan; Associate Professor, Department of Emergency Medicine, New York Medical College
Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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