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

Pisica, D.; Volovici, V.; Yue, J.K.; Van Essen, T.A.; Den Boogert, H.F.; Vande Vyvere, T.; Haitsma, I.; Nieboer, D.; Markowitz, A.J.; Yuh, E.L.; Steyerberg, E.W.; Peul, W.C.; Dirven, C.M.F.; Menon, D.K.; Manley, G.T.; Maas, A.I.R.; Lingsma, H.F.; Akerlund, C.; Amrein, K.; Andelic, N.; Andreassen, L.; Anke, A.; Antoni, A.; Audibert, G.; Azouvi, P.; Azzolini, M.L.; Bartels, R.; Barzo, P.; Beauvais, R.; Beer, R.; Bellander, B.-.; Belli, A.; Benali, H.; Berardino, M.; Beretta, L.; Blaabjerg, M.; Bragge, P.; Brazinova, A.; Brinck, V.; Brooker, J.; Brorsson, C.; Buki, A.; Bullinger, M.; Cabeleira, M.; Caccioppola, A.; Calappi, E.; Calvi, M.R.; Cameron, P.; Lozano, G.C.; Carbonara, M.; Cavallo, S.; Chevallard, G.; Chieregato, A.; Citerio, G.; Clusmann, H.; Coburn, M.; Coles, J.; Cooper, J.D.; Correia, M.; Covic, A.; Curry, N.; Czeiter, E.; Czosnyka, M.; Dahyot-Fizelier, C.; Dark, P.; Dawes, H.; De Keyser, V.; Degos, V.; Della Corte, F.; Boogert, H.D.; Depreitere, B.; Dilvesi, D.; Dixit, A.; Donoghue, E.; Dreier, J.; Duliere, G.-.; Ercole, A.; Esser, P.; Ezer, E.; Fabricius, M.; Feigin, V.L.; Foks, K.; Frisvold, S.; Furmanov, A.; Gagliardo, P.; Galanaud, D.; Gantner, D.; Gao, G.; George, P.; Ghuysen, A.; Giga, L.; Glocker, B.; Golubovic, J.; Gomez, P.A.; Gratz, J.; Gravesteijn, B.; Grossi, F.; Gruen, R.L.; Gupta, D.; Haagsma, J.A.; Helbok, R.; Helseth, E.; Horton, L.; Huijben, J.; Hutchinson, P.J.; Jacobs, B.; Jankowski, S.; Jarrett, M.; Jiang, J.-.; Johnson, F.; Jones, K.; Karan, M.; Kolias, A.G.; Kompanje, E.; Kondziella, D.; Kornaropoulos, E.; Koskinen, L.-.; Kovacs, N.; Kowark, A.; Lagares, A.; Lanyon, L.; Laureys, S.; Lecky, F.; Ledoux, D.; Lefering, R.; Legrand, V.; Lejeune, A.; Levi, L.; Lightfoot, R.; Castano-Leon, A.M.; Maegele, M.; Majdan, M.; Manara, A.; Manley, G.; Martino, C.; Marechal, H.; Mattern, J.; Mcmahon, C.; Melegh, B.; Menon, D.; Menovsky, T.; Mikolic, A.; Misset, B.; Muraleedharan, V.; Murray, L.; Negru, A.; Nelson, D.; Newcombe, V.; Nyiradi, J.; Olubukola, O.; Oresic, M.; Ortolano, F.; Palotie, A.; Parizel, P.M.; Payen, J.-.; Perera, N.; Perlbarg, V.; Persona, P.; Peul, W.; Piippo-Karjalainen, A.; Pirinen, M.; Pisica, D.; Ples, H.; Polinder, S.; Pomposo, I.; Posti, J.P.; Puybasset, L.; Radoi, A.; Ragauskas, A.; Raj, R.; Rambadagalla, M.; Helmrich, I.R.; Rhodes, J.; Richardson, S.; Richter, S.; Ripatti, S.; Rocka, S.; Roe, C.; Roise, O.; Rosand, J.; Rosenfeld, J.V.; Rosenlund, C.; Rosenthal, G.; Rossaint, R.; Rossi, S.; Rueckert, D.; Rusnak, M.; Sahuquillo, J.; Sakowitz, O.; Sanchez-Porras, R.; Sandor, J.; Schafer, N.; Schmidt, S.; Schoechl, H.; Schoonman, G.; Schou, R.F.; Schwendenwein, E.; Sewalt, C.; Singh, R.D.; Skandsen, T.; Smielewski, P.; Sorinola, A.; Stamatakis, E.; Stanworth, S.; Stevens, R.; Stewart, W.; Stocchetti, N.; Sundstrom, N.; Takala, R.; Tamas, V.; Tamosuitis, T.; Taylor, M.S.; B. T., A.; Tenovuo, O.; Theadom, A.; Thomas, M.; Tibboel, D.; Timmers, M.; Tolias, C.; Trapani, T.; Tudora, C.M.; Unterberg, A.; Vajkoczy, P.; Vallance, S.; Valeinis, E.; Vamos, Z.; Van Der Jagt, M.; Van Der Steen, G.; Van Der Naalt, J.; Van Dijck, J.T.J.M.; Van Erp, I.A.M.; Van Hecke, W.; Van Heugten, C.; Van Praag, D.; Van Veen, E.; Van Wijk, R.P.J.; Vargiolu, A.; Vega, E.; Velt, K.; Verheyden, J.; Vespa, P.M.; Vik, A.; Vilcinis, R.; Von Steinbuchel, N.; Voormolen, D.; Vulekovic, P.; Wang, K.K.W.; Whitehouse, D.; Wiegers, E.; Williams, G.; Wilson, L.; Winzeck, S.; Wolf, S.; Yang, Z.; Ylen, P.; Younsi, A.; Zeiler, F.A.; Zelinkova, V.; Ziverte, A.; Zoerle, T.

doi:10.1227/neu.0000000000002982

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 cm3 (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 cm3 (81%). Larger EDH volumes (odds ratio [OR] 1.19 [95% CI 1.14-1.24] per cm3 below 30 cm3), smaller ASDH volumes (OR 0.93 [95% CI 0.88-0.97] per cm3), 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 cm3 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.

Clinical and Imaging Characteristics, Care Pathways, and Outcomes of Traumatic Epidural Hematomas: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Study / D. Pisica, V. Volovici, J.K. Yue, T.A. Van Essen, H.F. Den Boogert, T. Vande Vyvere, I. Haitsma, D. Nieboer, A.J. Markowitz, E.L. Yuh, E.W. Steyerberg, W.C. Peul, C.M.F. Dirven, D.K. Menon, G.T. Manley, A.I.R. Maas, H.F. Lingsma, C. Akerlund, K. Amrein, N. Andelic, L. Andreassen, A. Anke, A. Antoni, G. Audibert, P. Azouvi, M.L. Azzolini, R. Bartels, P. Barzo, R. Beauvais, R. Beer, B.-. Bellander, A. Belli, H. Benali, M. Berardino, L. Beretta, M. Blaabjerg, P. Bragge, A. Brazinova, V. Brinck, J. Brooker, C. Brorsson, A. Buki, M. Bullinger, M. Cabeleira, A. Caccioppola, E. Calappi, M.R. Calvi, P. Cameron, G.C. Lozano, M. Carbonara, S. Cavallo, G. Chevallard, A. Chieregato, G. Citerio, H. Clusmann, M. Coburn, J. Coles, J.D. Cooper, M. Correia, A. Covic, N. Curry, E. Czeiter, M. Czosnyka, C. Dahyot-Fizelier, P. Dark, H. Dawes, V. De Keyser, V. Degos, F. Della Corte, H.D. Boogert, B. Depreitere, D. Dilvesi, A. Dixit, E. Donoghue, J. Dreier, G.-. Duliere, A. Ercole, P. Esser, E. Ezer, M. Fabricius, V.L. Feigin, K. Foks, S. Frisvold, A. Furmanov, P. Gagliardo, D. Galanaud, D. Gantner, G. Gao, P. George, A. Ghuysen, L. Giga, B. Glocker, J. Golubovic, P.A. Gomez, J. Gratz, B. Gravesteijn, F. Grossi, R.L. Gruen, D. Gupta, J.A. Haagsma, R. Helbok, E. Helseth, L. Horton, J. Huijben, P.J. Hutchinson, B. Jacobs, S. Jankowski, M. Jarrett, J.-. Jiang, F. Johnson, K. Jones, M. Karan, A.G. Kolias, E. Kompanje, D. Kondziella, E. Kornaropoulos, L.-. Koskinen, N. Kovacs, A. Kowark, A. Lagares, L. Lanyon, S. Laureys, F. Lecky, D. Ledoux, R. Lefering, V. Legrand, A. Lejeune, L. Levi, R. Lightfoot, A.M. Castano-Leon, M. Maegele, M. Majdan, A. Manara, G. Manley, C. Martino, H. Marechal, J. Mattern, C. Mcmahon, B. Melegh, D. Menon, T. Menovsky, A. Mikolic, B. Misset, V. Muraleedharan, L. Murray, A. Negru, D. Nelson, V. Newcombe, J. Nyiradi, O. Olubukola, M. Oresic, F. Ortolano, A. Palotie, P.M. Parizel, J.-. Payen, N. Perera, V. Perlbarg, P. Persona, W. Peul, A. Piippo-Karjalainen, M. Pirinen, D. Pisica, H. Ples, S. Polinder, I. Pomposo, J.P. Posti, L. Puybasset, A. Radoi, A. Ragauskas, R. Raj, M. Rambadagalla, I.R. Helmrich, J. Rhodes, S. Richardson, S. Richter, S. Ripatti, S. Rocka, C. Roe, O. Roise, J. Rosand, J.V. Rosenfeld, C. Rosenlund, G. Rosenthal, R. Rossaint, S. Rossi, D. Rueckert, M. Rusnak, J. Sahuquillo, O. Sakowitz, R. Sanchez-Porras, J. Sandor, N. Schafer, S. Schmidt, H. Schoechl, G. Schoonman, R.F. Schou, E. Schwendenwein, C. Sewalt, R.D. Singh, T. Skandsen, P. Smielewski, A. Sorinola, E. Stamatakis, S. Stanworth, R. Stevens, W. Stewart, N. Stocchetti, N. Sundstrom, R. Takala, V. Tamas, T. Tamosuitis, M.S. Taylor, B.T. Ao, O. Tenovuo, A. Theadom, M. Thomas, D. Tibboel, M. Timmers, C. Tolias, T. Trapani, C.M. Tudora, A. Unterberg, P. Vajkoczy, S. Vallance, E. Valeinis, Z. Vamos, M. Van Der Jagt, G. Van Der Steen, J. Van Der Naalt, J.T.J.M. Van Dijck, I.A.M. Van Erp, W. Van Hecke, C. Van Heugten, D. Van Praag, E. Van Veen, R.P.J. Van Wijk, A. Vargiolu, E. Vega, K. Velt, J. Verheyden, P.M. Vespa, A. Vik, R. Vilcinis, N. Von Steinbuchel, D. Voormolen, P. Vulekovic, K.K.W. Wang, D. Whitehouse, E. Wiegers, G. Williams, L. Wilson, S. Winzeck, S. Wolf, Z. Yang, P. Ylen, A. Younsi, F.A. Zeiler, V. Zelinkova, A. Ziverte, T. Zoerle. - In: NEUROSURGERY ONLINE. - ISSN 1524-4040. - 95:5(2024), pp. 986-999. [10.1227/neu.0000000000002982]

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

Pisica D.;Volovici V.;Yue J. K.;Van Essen T. A.;Den Boogert H. F.;Vande Vyvere T.;Haitsma I.;Nieboer D.;Markowitz A. J.;Yuh E. L.;Steyerberg E. W.;Peul W. C.;Dirven C. M. F.;Menon D. K.;Manley G. T.;Maas A. I. R.;Lingsma H. F.;Akerlund C.;Amrein K.;Andelic N.;Andreassen L.;Anke A.;Antoni A.;Audibert G.;Azouvi P.;Azzolini M. L.;Bartels R.;Barzo P.;Beauvais R.;Beer R.;Bellander B. -M.;Belli A.;Benali H.;Berardino M.;Beretta L.;Blaabjerg M.;Bragge P.;Brazinova A.;Brinck V.;Brooker J.;Brorsson C.;Buki A.;Bullinger M.;Cabeleira M.;A. Caccioppola;Calappi E.;Calvi M. R.;Cameron P.;Lozano G. C.;Carbonara M.;Cavallo S.;G. Chevallard;Chieregato A.;Citerio G.;Clusmann H.;Coburn M.;Coles J.;Cooper J. D.;Correia M.;Covic A.;Curry N.;Czeiter E.;Czosnyka M.;Dahyot-Fizelier C.;Dark P.;Dawes H.;De Keyser V.;Degos V.;Della Corte F.;Boogert H. D.;Depreitere B.;Dilvesi D.;Dixit A.;Donoghue E.;Dreier J.;Duliere G. -L.;Ercole A.;Esser P.;Ezer E.;Fabricius M.;Feigin V. L.;Foks K.;Frisvold S.;Furmanov A.;Gagliardo P.;Galanaud D.;Gantner D.;Gao G.;George P.;Ghuysen A.;Giga L.;Glocker B.;Golubovic J.;Gomez P. A.;Gratz J.;Gravesteijn B.;Grossi F.;Gruen R. L.;Gupta D.;Haagsma J. A.;Helbok R.;Helseth E.;Horton L.;Huijben J.;Hutchinson P. J.;Jacobs B.;Jankowski S.;Jarrett M.;Jiang J. -Y.;Johnson F.;Jones K.;Karan M.;Kolias A. G.;Kompanje E.;Kondziella D.;Kornaropoulos E.;Koskinen L. -O.;Kovacs N.;Kowark A.;Lagares A.;Lanyon L.;Laureys S.;Lecky F.;Ledoux D.;Lefering R.;Legrand V.;Lejeune A.;L. Levi;Lightfoot R.;Castano-Leon A. M.;Maegele M.;Majdan M.;Manara A.;Manley G.;Martino C.;Marechal H.;Mattern J.;Mcmahon C.;Melegh B.;Menon D.;Menovsky T.;Mikolic A.;Misset B.;Muraleedharan V.;L. Murray;Negru A.;Nelson D.;Newcombe V.;Nyiradi J.;Olubukola O.;Oresic M.;F. Ortolano;Palotie A.;Parizel P. M.;Payen J. -F.;Perera N.;Perlbarg V.;Persona P.;Peul W.;Piippo-Karjalainen A.;Pirinen M.;Pisica D.;Ples H.;Polinder S.;Pomposo I.;Posti J. P.;Puybasset L.;Radoi A.;Ragauskas A.;Raj R.;Rambadagalla M.;Helmrich I. R.;Rhodes J.;Richardson S.;Richter S.;Ripatti S.;Rocka S.;Roe C.;Roise O.;Rosand J.;Rosenfeld J. V.;Rosenlund C.;Rosenthal G.;Rossaint R.;Rossi S.;Rueckert D.;Rusnak M.;Sahuquillo J.;Sakowitz O.;Sanchez-Porras R.;Sandor J.;Schafer N.;Schmidt S.;Schoechl H.;Schoonman G.;Schou R. F.;Schwendenwein E.;Sewalt C.;Singh R. D.;Skandsen T.;Smielewski P.;Sorinola A.;Stamatakis E.;Stanworth S.;Stevens R.;Stewart W.;N. Stocchetti;Sundstrom N.;Takala R.;Tamas V.;Tamosuitis T.;Taylor M. S.;Ao B. T.;Tenovuo O.;Theadom A.;Thomas M.;Tibboel D.;Timmers M.;Tolias C.;Trapani T.;Tudora C. M.;Unterberg A.;Vajkoczy P.;Vallance S.;Valeinis E.;Vamos Z.;Van Der Jagt M.;Van Der Steen G.;Van Der Naalt J.;Van Dijck J. T. J. M.;Van Erp I. A. M.;Van Hecke W.;Van Heugten C.;Van Praag D.;Van Veen E.;Van Wijk R. P. J.;Vargiolu A.;Vega E.;Velt K.;Verheyden J.;Vespa P. M.;Vik A.;Vilcinis R.;Von Steinbuchel N.;Voormolen D.;Vulekovic P.;Wang K. K. W.;Whitehouse D.;Wiegers E.;Williams G.;Wilson L.;Winzeck S.;Wolf S.;Yang Z.;Ylen P.;Younsi A.;Zeiler F. A.;Zelinkova V.;Ziverte A.;T. Zoerle^Ultimo

2024

Abstract

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 cm3 (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 cm3 (81%). Larger EDH volumes (odds ratio [OR] 1.19 [95% CI 1.14-1.24] per cm3 below 30 cm3), smaller ASDH volumes (OR 0.93 [95% CI 0.88-0.97] per cm3), 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 cm3 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.

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	Parole chiave
	
				Clinical decision-making; Cranial epidural hematoma; Guideline; Neurosurgical procedure; Traumatic brain injury
			
	Settori scientifico-disciplinari dell'articolo (validi dal 09/05/2024)
	
				Settore MEDS-23/A - Anestesiologia
			
	Titolo del progetto
	
	Titolo Progetto
	
									Collaborative European NeuroTrauma Effectiveness Research in TBI
								
	Acronimo
	
									CENTER-TBI
								
	Nome finanziatore
	
										European Commission
									
	Finanziamento
	
									SEVENTH FRAMEWORK PROGRAMME
								
	N. Contratto
	
									602150
								
	Data di pubblicazione
	
				2024
			
	Rivista in ANCE
	
				NEUROSURGERY ONLINE
			
	DOI
	
				https://dx.doi.org/10.1227/neu.0000000000002982
			
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				Article (author)
			
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				01 - Articolo su periodico

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