CT Evaluation of Post-traumatic Extradural Hemorrhage Volume: Correlation with Brain Parenchymal Changes Clinical Outcomes

Abstract

Introduction: Traumatic brain injury (TBI) lead significant morbidity and mortality with common causes including motor vehicle accidents, falls, assaults and sports injuries.

Objective: Quantify extradural hemorrhage volume in traumatic head injuries and evaluate its impact on brain parenchyma and clinical decision-making.

Methods: A prospective observational study was conducted at Jubilee Mission Medical College, Kerala over 18 months including 50 patients with CT-confirmed EDH. Data were analysed to assess their impact of EDH volume on brain parenchymal changes and treatment decisions. Statistical analyses included descriptive statistics, correlation coefficients, unpaired t-tests, ANOVA and chi-square tests.

Results: In the study, 70% of the patients were male averaging 45 years old and 70% of injuries resulted from motor vehicle accidents. Larger volumes of EDH are linked to midline shift (16.5cc), cerebral edema (17.5cc), cerebral herniation (18cc) and basal cistern compression (20cc).  Conservative management was the predominant approach with 45 cases (90%) treated conservatively compared to 5 cases receiving surgical intervention. EDH volume showed moderate sensitivity (73.3%) and high specificity (80.0%) meaning that approximately 80% of patients with large EDH volumes were accurately identified as needing surgical treatment with high positive predictive value (PPV) of 97.1% and low negative predictive value (NPV) of 25.0%.

Conclusion: Larger EDH volumes correlate with more severe clinical outcomes, influencing the need for surgical intervention. However, the predictive capacity of EDH volume alone is limited, suggesting the need for a comprehensive approach including advanced imaging.