FACTORS INFLUENCING THE FUNCTIONAL OUTCOME OF PATIENTS WITH ACUTE EPIDURAL HEMATOMAS - ANALYSIS OF 200 PATIENTS UNDERGOING SURGERY

Objective: To determine the prognostic factors of the functional outco me of patients surgically treated for acute epidural hematomas. Method s: Two hundred patients who consecutively underwent neurosurgery for a cute epidural hematomas over the past 9-year period were studied. Clin ical characteristics, radiologic findings, and the time intervals with regard to treatment course were investigated to determine the interac tions between all these factors and functional outcome. Results: Funct ional outcome showed a significant correlation with preoperative consc iousness state, Glasgow Coma Scale score, pupillary sizes, and motor p osturing (chi(2) test, p < 0.05). Functional outcome correlated with t he period of brain hernia tion, the length of time of the operation, a s well as the period of hospitalization (chi(2) test, p < 0.05), but n ot with the length of time of craniotomy decompression relative to the length of time from the injury until admission. The radiologic findin gs of the associated brain injury, the size and the density of the clo t, the degree of the brain shift, and the obliteration of the basal ci sterns significantly correlated with functional outcome (chi(2) test, p < 0.05), whereas no significance was attributable to skull fracture. Multivariate analysis indicated that the following four factors indep endently correlated with functional outcome: (1) associated brain inju ry, (2) best motor response, (3) hematoma volume, and (4) period of ho spitalization (chi(2) test, p < 0.05). A combination of the four facto rs led to the prediction of the functional outcome with 91% accuracy ( 1.5% falsely pessimistic predictions and 7.5% falsely optimistic predi ction) and 82.1% at over 90% confidence level, These four parameters c orrelated significantly with preoperative neurologic deterioration (ch i(2) test, p < 0.05). Conclusion: This study identifies the risk facto rs involved in the functional outcome of patients who underwent surgic al treatment for acute epidural hematomas, Our results indicate that a ssociated brain injury plus best motor response are the optimal set of two prognostic indicants, with 87% correct predictions and 70.1% at o ver a 90% confidence level, Prevention of in-hospital neurologic deter ioration would improve the patients' functional outcome with a resulta nt unfavorable recovery rate ranging from 11.5% to 17%.