The Impact of Time till Surgery on Post-Operative Outcome of Traumatic Extradural Hematoma


  • Waseef Ullah
  • Amer Zaman
  • Junaid Alam
  • Hameed Ullah
  • Irfan Ali
  • Irfan Ali
  • Irfan Ali
  • Faisal Shahzad



Extradural Hematoma


Objective:  Traumatic extradural hematoma (EDH) is a common complication of head injuries, predominantly affecting the working-age male population due to increased outdoor activity. This study aimed to assess the impact of timing in surgical intervention and identify factors influencing outcomes.

Materials and Methods:  Seventy-eight consecutive patients diagnosed with traumatic EDH at Lady Reading Hospital, Peshawar, were included. Patients were categorized into two groups based on the timing of presentation: within 6 hours (early) and after 6 hours (late). Craniotomy and hematoma evacuation were performed, and outcomes were assessed at discharge.

Results:  In our study mean and SDs for age were 21.83±31.57. Most of the patients i.e., 54(69.2%) were from the 2nd and 3rd decade of life. The mean hematoma volume was 37.17 ml. The majority of the patients were males 65(83.3%) and RTA 32(42.02%) was the most common cause followed by falls and physical assault respectively. The outcome of early operated (within 6 hours) patients was favorable in 44(95.65%) while 2 (4.34%) did not improve (GOS 2,3). Favorable outcomes (GOS 4,5) in delayed presented patients who operated after 6 hours were 23 (71.87%). 5(15.6%) were not improved (GOS 2,3) and 4(12.5%) died (GOS 1).

Conclusion:  Outcomes of patients who operated early are more favorable than those who were operated late. Delayed presentation and intervention increase the mortality and morbidity of patients having traumatic extradural hematoma.


Soon WC, Marcus H, Wilson M. Traumatic acute extradural haematoma – Indications for surgery revisited. Br J Neurosurg. 2016;30(2):233-4.

Niaz A NM, Niraula K, Majeed S, Neupane J, Ghimire M, Vohra A. Factors Affecting the Surgical Outcome in Extradural Hematoma in Punjab Institute of Neurosciences, Lahore, Pakistan. Nepal Journal of Neuroscience. 2017;14(3):13-8.

Bhat AR, Kirmani AR, Wani MA. Disappearance of Intracranial Extradural Hematomas: Role of Diastatic Cranial Fracture and Intracranial Pressure – An Institutional Experience. Asian J Neurosurg. 2018;13(2):375-9.

Adams H, Kolias AG, Hutchinson PJ. The Role of Surgical Intervention in Traumatic Brain Injury. Neurosurgery Clinics. 2016;27(4):519-28.

Gutowski P, Meier U, Rohde V, Lemcke J, von der Brelie C. Clinical Outcome of Epidural Hematoma Treated Surgically in the Era of Modern Resuscitation and Trauma Care. World Neurosurg. 2018;118:e166-e74.

Krishna G, Beitchman JA, Bromberg CE, Currier Thomas T. Approaches to Monitor Circuit Disruption after Traumatic Brain Injury: Frontiers in Preclinical Research. Int J Mol Sci. 2020;21(2).

P Prahaladu, M V Vijay Sekhar, K Satyavara Prasad, Hemal Chheda. Assessment of Extra Dural Hematoma – Factors affecting morbidity, mortality and outcome. IAIM. 2019;6(9):102-7.

Kandregula S, Sadashiva N, Konar S, Rao KN, Shukla D, Bhat D, et al. Surgical management of traumatic extradural hematomas in children: an analysis of 201 patients at a tertiary neurosurgical center. Child's nervous system: ChNS: official journal of the International Society for Pediatric Neurosurgery. 2019;35(5):807-13.

Matsushima, K., et al. “Emergent operation for isolated severe traumatic brain injury: Does time matter?” Journal of Trauma and Acute Care Surgery 2015;79(5): 838-84

Kulesza B, Litak J, Grochowski C, Nogalski A, Rola R. The Initial Factors with Strong Predictive Value in Relation to Six-Month Outcome among Patients Operated due to Extra-Axial Hematomas. Diagnostics (Basel). 2020;10(3):174.

Provisional summary results of 6th population and housing census – 2017: Pakistan bureau of statistics, Government of Pakistan; 2017 [Available from: census-2017-0.

Mushtaq, Rehman L, Khaleeq S, Zaman KU. Association of outcome of traumatic extradural haematoma with glasgow coma scale and haematoma size. Ann. Pak. Inst. Med. Sci. 2010;6(3):133-8.

Dur and P, Adamson GJ . On the field management of athletic head injuries. J Am Acad Orthop Surg 2004;12(3):191-5.

Mahmood S, Mahmood R, Ali S, Mirza I, Butt R. Surgical outcome of traumatic brain injury: a retrospective experience of two months at Lahore general hospital, Lahore. Pak .J of Neuronal . surg. 2019:23(1):23-27.

Arrind D, Shibu VP, Kolleri S. Does volume of extradural hematoma influence management strategy and outcome. Neurol India 2004;52(4):443-5.

Hyder AA, Wunderlich CA, Puvanachandra P, Gururaj G Kobusingye OC. The impact of traumatic brain injuries: a global perspective. Neuro Rehabilitation. 2007;22(5):341-53

Tsang KK, Whitfield PC. Traumatic brain injury: review of current management strategies. British Journal of Oral and Maxillofacial Surgery. 2012 Jun 1;50(4):298-308.

Khaled CN, Raihan MZ, Chowdhury FH, Ashadullah AT, Sarkar MH, Hossain SS. Surgical management of traumatic extradural haematoma: Experiences with 610 patients and prospective analysis. The Indian Journal of Neurotrauma. 2008;5(2):75-9.

Ayub S, Ali M, Ilyas M. Acute extradural hematoma; factors affecting out comes. JPMI. 2005;19(2):208-211.

Oertel M, Kelly DF, McArthur D, Boscardin WJ, Glenn TC, Lee JH, Gravori T. Progressive hemorrhage after head trauma: J Nenrosurg. 2002;96:109-16.

Servadei F, Faccani G, Rocella P, et al. Asymptomatic extradural haematomas. Results of a multicentre study of 158 cases in minor head injury. Acta Neurochir Wien 1989;96:39-45.

Ramzan A, Wani A, Malik AH, Kirmani A, Wani M. Acute bilateral extradural hematomas. Neurology India. 2002;50(2):217.

Kelly DF, Becker DP. Advances in management of neurosurgical trauma: USA and Canada. World Journal of Surgery. 2001;25(9):1179.

Babu ML, Bhasin SK, Kumar A. Extradural hematoma-an experience of 300 cases. JK Science. 2005;7(4):205-7.

Jamous MA, Aziz HA, Al Kaisy F, Eloqayli H, Azab M, Al-Jarrah M. Conservative management of acute epidural hematoma in a pediatric age group. Pediatric neurosurgery. 2009;45(3):181-4.

Shin JJ, Kuh SU, Cho YE. Surgical management of spontaneous spinal epidural hematoma. European Spine Journal. 2006 Jun; 15(6):998-1004.

Ortler M, Lang Mayr JJ, Stockinger A, Golser K, RusseggerL, Resch H. Post operative outcome of traumatic brain injury. Surg Neurol 1997;48(2):193-1.






Original Articles