The International Journal of Medical Science and Health Research
Surgical outcomes of acute epidural hematoma evacuation: Timing of intervention and predictors of outcome — a systematic review of randomized controlled trial and primary studies
By Nur Alam Sulaiman and Nirmalasari.
Abstract
Introduction
Acute epidural hematoma (EDH) is a time-critical neurosurgical emergency in which prompt evacuation can convert a potentially lethal mass lesion into a fully recoverable injury. Outcomes nevertheless vary widely, particularly in low- and middle-income countries (LMICs) where computed tomography (CT), neurosurgeons, operating theatres and referral systems are unevenly distributed. This review aimed to quantify contemporary mortality and functional outcome after surgical evacuation of acute EDH, to estimate the association between delayed surgery and outcome, to identify pre-operative predictors of outcome, and to synthesise evidence on facility- and human resource-related causes of delay.
Methods
The study strictly adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines. Randomized controlled trials and prospective, retrospective, cohort, case-control and cross-sectional studies of patients undergoing surgical evacuation of traumatic acute EDH were eligible. Risk of bias was assessed with the Quality In Prognosis Studies (QUIPS) tool and the Newcastle–Ottawa Scale. Proportions were pooled on the logit scale and odds ratios (ORs) with DerSimonian–Laird random-effects models; Mantel–Haenszel and Peto methods, leave-one-out analyses, subgroup analyses, meta-regression and funnel-plot tests were used for robustness. Certainty of evidence was graded with GRADE for prognosis.