Surgical outcomes of acute epidural hematoma evacuation: Timing of intervention and predictors of outcome — a systematic review of randomized controlled trial and primary studies

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.