Clinical and Imaging Characteristics, Care Pathways, and Outcomes of Traumatic Epidural Hematomas: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Study.

Pisică, Dana; Volovici, Victor; Yue, John K; van Essen, Thomas A; den Boogert, Hugo F; Vande Vyvere, Thijs; Haitsma, Iain; Nieboer, Daan; Markowitz, Amy J; Yuh, Esther L; Steyerberg, Ewout W; Peul, Wilco C; Dirven, Clemens M F; Menon, David K; Manley, Geoffrey T; Maas, Andrew I R; Lingsma, Hester F; CENTER-TBI Participants and Investigators

doi:10.1227/neu.0000000000002982

Article (Scientific journals)

Clinical and Imaging Characteristics, Care Pathways, and Outcomes of Traumatic Epidural Hematomas: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Study.

Pisică, Dana; Volovici, Victor; Yue, John K et al.

2024 • In Neurosurgery, 95 (5), p. 986 - 999

Peer Reviewed verified by ORBi

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https://hdl.handle.net/2268/328392

DOI
10.1227/neu.0000000000002982

PubMed
38771081

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Keywords :

Humans; Male; Female; Adult; Middle Aged; Europe; Young Adult; Treatment Outcome; Critical Pathways; Hematoma, Subdural, Acute/surgery; Hematoma, Subdural, Acute/diagnostic imaging; Longitudinal Studies; Prospective Studies; Cohort Studies; Hematoma, Epidural, Cranial/surgery; Hematoma, Epidural, Cranial/diagnostic imaging; Brain Injuries, Traumatic/diagnostic imaging; Brain Injuries, Traumatic/surgery; Brain Injuries, Traumatic/complications; Clinical decision-making; Cranial epidural hematoma; Guideline; Neurosurgical procedure; Traumatic brain injury; Brain Injuries, Traumatic; Hematoma, Epidural, Cranial; Hematoma, Subdural, Acute; Surgery; Neurology (clinical)

Abstract :

[en] [en] BACKGROUND AND OBJECTIVES: Guideline recommendations for surgical management of traumatic epidural hematomas (EDHs) do not directly address EDHs that co-occur with other intracranial hematomas; the relative rates of isolated vs nonisolated EDHs and guideline adherence are unknown. We describe characteristics of a contemporary cohort of patients with EDHs and identify factors influencing acute surgery. METHODS: This research was conducted within the longitudinal, observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury cohort study which prospectively enrolled patients with traumatic brain injury from 65 hospitals in 18 European countries from 2014 to 2017. All patients with EDH on the first scan were included. We describe clinical, imaging, management, and outcome characteristics and assess associations between site and baseline characteristics and acute EDH surgery, using regression modeling. RESULTS: In 461 patients with EDH, median age was 41 years (IQR 24-56), 76% were male, and median EDH volume was 5 cm 3 (IQR 2-20). Concomitant acute subdural hematomas (ASDHs) and/or intraparenchymal hemorrhages were present in 328/461 patients (71%). Acute surgery was performed in 99/461 patients (21%), including 70/86 with EDH volume ≥30 cm 3 (81%). Larger EDH volumes (odds ratio [OR] 1.19 [95% CI 1.14-1.24] per cm 3 below 30 cm 3 ), smaller ASDH volumes (OR 0.93 [95% CI 0.88-0.97] per cm 3 ), and midline shift (OR 6.63 [95% CI 1.99-22.15]) were associated with acute surgery; between-site variation was observed (median OR 2.08 [95% CI 1.01-3.48]). Six-month Glasgow Outcome Scale-Extended scores ≥5 occurred in 289/389 patients (74%); 41/389 (11%) died. CONCLUSION: Isolated EDHs are relatively infrequent, and two-thirds of patients harbor concomitant ASDHs and/or intraparenchymal hemorrhages. EDHs ≥30 cm 3 are generally evacuated early, adhering to Brain Trauma Foundation guidelines. For heterogeneous intracranial pathology, surgical decision-making is related to clinical status and overall lesion burden. Further research should examine the optimal surgical management of EDH with concomitant lesions in traumatic brain injury, to inform updated guidelines.

Disciplines :

Anesthesia & intensive care

Author, co-author :

Pisică, Dana; Department of Public Health, Center for Medical Decision Making, Erasmus MC - University Medical Center Rotterdam, Rotterdam , the Netherlands ; Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam , the Netherlands

Volovici, Victor; Department of Public Health, Center for Medical Decision Making, Erasmus MC - University Medical Center Rotterdam, Rotterdam , the Netherlands ; Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam , the Netherlands

Yue, John K; Department of Neurosurgery, University of California, San Francisco, San Francisco , California , USA ; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco , California , USA

van Essen, Thomas A; University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague , the Netherlands ; Department of Neurosurgery, Leiden University Medical Center, Leiden , the Netherlands ; Division of Neurosurgery, Department of Surgery, QEII Health Sciences Centre and Dalhousie University, Halifax , Nova Scotia , Canada

den Boogert, Hugo F; University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague , the Netherlands ; Department of Neurosurgery, Radboud University Medical Center, Nijmegen , the Netherlands

Vande Vyvere, Thijs; Department of Radiology, Antwerp University Hospital and University of Antwerp, Antwerp , Belgium

Haitsma, Iain; Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam , the Netherlands

Nieboer, Daan; Department of Public Health, Center for Medical Decision Making, Erasmus MC - University Medical Center Rotterdam, Rotterdam , the Netherlands

Markowitz, Amy J; Department of Neurosurgery, University of California, San Francisco, San Francisco , California , USA ; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco , California , USA

Yuh, Esther L; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco , California , USA ; Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco , California , USA

More authors (8 more)

Other collaborator :

Ledoux, Didier ; Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs généraux

Language :

English

Title :

Clinical and Imaging Characteristics, Care Pathways, and Outcomes of Traumatic Epidural Hematomas: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Study.

Publication date :

01 November 2024

Journal title :

Neurosurgery

ISSN :

0148-396X

eISSN :

1524-4040

Publisher :

Lippincott Williams and Wilkins, United States

Volume :

Issue :

Pages :

986 - 999

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

https://journals.lww.com/10.1227/neu.0000000000002982

European Projects :

FP7 - 602150 - CENTER-TBI - Collaborative European NeuroTrauma Effectiveness Research in TBI

Funders :

EU - European Union
ZNS Hannelore Kohl Stiftung
One Mind
Integra LifeSciences (United States)
NREF - Neurosurgery Research and Education Foundation

Funding text :

The authors' work on this study is funded by the European Union's Seventh Framework Program (FP7/2007-2013) under grant agreement number 602150 (CENTER-TBI). Additional support for CENTER-TBI was obtained from the Hannelore Kohl Stiftung (Germany), from OneMind (USA), from Integra LifeSciences Corporation (USA), and from NeuroTrauma Sciences (USA). John K. Yue received funding from the Neurosurgery Research and Education Foundation & Bagan Family Foundation Research Fellowship (USA; Award #A139203). The funding entities had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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