Traumatic Epidural Hematoma in Emergency Department

Yıl 2023, Cilt: 6 Sayı: 4, 155 - 159, 29.12.2023

Yeliz Simsek Gonca Şahin

https://doi.org/10.54996/anatolianjem.1197285

Öz

Aim: In our study, we investigated the incidence, demographic, and clinical characteristics of patients who were diagnosed with Epidural Hematoma (EH). Thus, we aim to contribute to the definition of risk classification and prognostic factors.

Material and Methods: Patients who were admitted to the emergency department and diagnosed with EH over the age of 17 were screened retrospectively between January 1, 2020 and May 30, 2022. The demographic data, physiological parameters, the Glasgow Coma Score (GCS), computed tomography scan result, treatment decision, and the Glasgow Outcome Score (GOS) of patients were analyzed. The Chi-square test was used to analyze categorical variables. The Spearman correlation test, Mann-Whitney U-test, and Independent Sample test were used to analyze continuous variables. Based on significant factors in univariate analysis, a Receiver Operating Characteristic (ROC) curve was calculated and The Area Under Curve (AUC) value was found. P<0.05 was considered statistically significant.

Results: Twenty-eight (90.3%) of 31 patients were male. The maximum age of patients was in the third decade. The majority of patients had mild head injuries (51.6%). Nineteen (61.3%) patients had isolated EH. EH was mostly located in the temporal region (67.7%). Of 31 patients, eight (25.8%) had a depressed fracture, and 15 (48.4%) had a nondepressed fracture. Emergency surgery was performed in 11 (35.5%) of the patients. There was a significant relationship between the age and the presence of fractures (p=0.009). We found a significant relationship between the GCS and depressed fracture, treatment decision, and length of hospital stay (p=0.042, p=0.002, p=0.042). A significant correlation was found between the GOS and the GCS (p=0.012).

Conclusion: EH is more common in young adults. A cranial fracture may be a sign for the EH. The GCS is important for prognosis in EH patients.

Anahtar Kelimeler

Epidural Hematoma, emergency department, glasgow coma score

Acil Serviste Travmatik Epidural Hematom

Öz

Amaç: Çalışmamızda, Epidural Hematom (EH) tanısı alan hastaların insidansını, demografik ve klinik özelliklerini inceledik. Risk sınıflaması ve prognostik faktörlerin tanımlanmasına katkı sağlamayı amaçladık.

Gereç ve Yöntemler: 1 Ocak 2020 - 30 Mayıs 2022 tarihleri arasında acil serviste EH tanısı alan 17 yaş üstü hastalar retrospektif olarak incelendi. Demografik özellikler, fizyolojik parametreler, Glasgow Koma Skoru (GKS), hastaların bilgisayarlı beyin tomografi sonucu, tedavi kararı ve Glasgow Sonuç Skoru (GOS) analiz edildi. Kategorik değişkenlerin analizinde Ki-kare testi kullanıldı. Sürekli değişkenlerin analizinde Spearman korelasyon testi, Mann-Whitney U testi ve Independent Sample testi kullanıldı. Unıvariate analizde anlamlı bulunan faktörlerin etkinliği ROC (Receiver Operating Characteristic) eğrisi kullanılarak karşılaştırıldı ve Area Under Curve (AUC) değeri hesaplandı. P<0,05 istatistiksel olarak anlamlı kabul edildi.

Bulgular: 31 hastanın 28'i (%90,3) erkekti. Hastalar en fazla üçüncü dekatta gözlendi. Hastaların çoğunda (%51,6) hafif kafa travması vardı. On dokuz (%61.3) hastada izole EH vardı. EH en çok temporal bölgede idi (%67,7). 31 hastanın 8'inde (%25,8) deplase kırık, 15'inde (%48,4) deplase olmayan kırık vardı. Hastaların 11'ine (%35,5) acil cerrahi uygulandı. Yaş ile kırık varlığı arasında anlamlı bir ilişki vardı (p=0,009). GKS ile deplase kırık, tedavi kararı ve hastanede kalış süresi arasında anlamlı ilişki bulduk (p=0,042, p=0,002, p=0,042). GOS ile GCS arasında anlamlı korelasyon vardı (p=0,012).

Sonuç: EH genç erişkinlerde daha sıktır. Kafatası kırığı EH için bir işaret olabilir. EH hastalarında GKS prognoz için önemlidir.

Anahtar Kelimeler

Epidural hematom, acil servis, glasgow koma skoru

Kaynakça

• Maruna P, Nedelníková K, Gürlich R. Physiology and genetics of procalcitonin. Physiol Res. 2000;49 Suppl 1:S57-S61.
• Becker KL, Nylén ES, White JC, et al. Clinical review 167: Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab. 2004 Apr;89(4):1512-25.
• Cleland DA, Eranki AP. Procalcitonin. In: StatPearls. Treasure Island (FL): StatPearls Publishing; September 16, 2019.
• So-Ngern A, Leelasupasri S, Chulavatnatol S, et al. Prognostic Value of Serum Procalcitonin level for the Diagnosis of Bacterial Infections in Critically-ill Patients. Infect Chemother. 2019 Sep;51(3):263-273
• Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021 Nov;47(11):1181-1247.
• AlRawahi AN, AlHinai FA, Doig CJ, et al. The prognostic value of serum procalcitonin measurements in critically injured patients: a systematic review. Crit Care. 2019 Dec 3;23(1):390.
• Sandek A, Springer J, Habedank D, et al. Procalcitonin-guided antibiotic treatment in heart failure. Lancet. 2004;363(9420):1555-1556.
• Rowland T, Hilliard H, Barlow G. Procalcitonin: potential role in diagnosis and management of sepsis. Adv Clin Chem. 2015;68:71-86.
• Dai J, Xia B, Wu X. Elevated plasma procalcitonin level predicts poor prognosis of ST elevation myocardial infarction in Asian elderly. Scand J Clin Lab Invest. 2018 Feb-Apr;78(1-2):49-54.
• Tan M, Lu Y, Jiang H, et al. The diagnostic accuracy of procalcitonin and C-reactive protein for sepsis: A systematic review and meta-analysis. J Cell Biochem. 2019 Apr;120(4):5852-5859.
• Pedersen M, Brandt VS, Holler JG, et al. Lactate level, aetiology and mortality of adult patients in an emergency department: a cohort study. Emerg Med J. 2015;32(9):678-684.
• Arora S, Singh P, Singh PM, et al. Procalcitonin Levels in Survivors and Nonsurvivors of Sepsis: Systematic Review and Meta-Analysis. Shock. 2015;43(3):212-221.
• Gök RGY, Gök A, Bulut M. Assessing prognosis with modified early warning score, rapid emergency medicine score and worthing physiological scoring system in patients admitted to intensive care unit from emergency department. Int Emerg Nurs. 2019 Mar;43:9-14.
• Nannan Panday RS, Minderhoud TC, Alam N, et al. Prognostic value of early warning scores in the emergency department (ED) and acute medical unit (AMU): A narrative review. Eur J Intern Med. 2017 Nov;45:20-31.
• Fernandes L, Arora AS, Mesquita AM. Role of Semi-quantitative Serum Procalcitonin in Assessing Prognosis of Community Acquired Bacterial Pneumonia Compared to PORT PSI, CURB-65 and CRB-65. J Clin Diagn Res. 2015;9(7):OC01-OC4.