COMPARATIVE OUTCOMES OF CONSERVATIVE VERSUS SURGICAL MANAGEMENT OF TRAUMATIC EXTRADURAL HEMATOMA IN RURAL INDIA

Background: To study and compare the role of conservative management and surgical intervention in traumatic extradural hematoma (EDH) in rural India. Setting: Government Medical College, Miraj, Maharashtra state, India. Materials and methods: 240 trauma patients diagnosed as extradural hematoma on CT scan were managed during 2 year period. Outcomes: Comparative role of conservative management and surgical intervention were studied. Results: Out of these 240 patients admitted 134 were managed conservatively, 106 cases were operated upon. 62 were operated upon immediately and 44 were operated upon as delayed. There were 2 deaths and 8 had poor outcome in this group of patients. Conclusion: It is stressed that small size <10 ml, GCS > 12 and locations other than temporal area are the criteria for conservative management. 44 patients out of 178 were needed to be treated surgically during the course of conservative management due to neuro deterioration, increase in size of hematoma on CT, bradycardia, hemiparesis, pupillary abnormalities, delay in referral and only 18% had poor outcome. A strict vigilance is to be kept for clinical deterioration and various reasons mentioned above are to be kept in mind and patients should be subjected to repeated CT scan. Early diagnosis and immediate surgical intervention had good outcome, which shows the rewarding results of early diagnosis and intervention.