PROGNOSIS AND CLINICAL RELEVANCE OF ANISOCORIA-CRANIOTOMY LATENCY FOREPIDURAL HEMATOMA IN COMATOSE PATIENTS

Objective: To determine whether the time between onset of anisocoria a nd surgery for hematoma evacuation in the head-injured patient is a us eful prognostic variable for outcome in the comatose patient with an a cute epidural hematoma, Design: Prospective, Materials and Methods: Tw enty-one patients with an acute traumatic epidural hematoma and an adm ission Glasgow Coma Scale score of less than 8 were analyzed,Results: Anisocoria was present in 14 (67%) patients, Mortality rate was three times higher in this group than in the patients without anisocoria; ho wever, this difference was not statistically significant (p = 0.21, Fi sher's exact test), None of the patients with an anisocoria-craniotomy latency of 70 minutes or less died and ail of these patients had a go od or reasonable outcome, Analysis of the anisocoria-craniotomy latenc y in ten patients revealed that a lapse of more than 90 minutes was as sociated with a greater mortality compared with patients with a latenc y of less than 90 minutes (p = 0.0238, Fisher's exact test), Conclusio ns: In patients with an acute epidural hematoma, reducing the anisocor ia-surgery interval below 90 minutes is significantly associated with a better outcome (p = 0.0238, Fisher's exact test).