Multidisciplinary Approach to the Management of Traumatic Epidural Hematoma: Pathophysiology, Treatment, and Outcomes
Afnan Mohammed Al Dosari 1, Eman Ibrahim Alshaikh Ali 1, Khwlah Abdulaziz Alswaied 1, Mohammed Naif Al Mutairi 1, Abdulkarim Shunayn Safi Alanazi 1, Fahad Husayyan Al Enazi 1, Nada Abdulrahman Amer Alajmi 1, Ali Abdullah Mohammed Alajlan 1, Ahmad Asri Awad Alanazi 1, Abdulrahman Ibrahim Abdullah Al Fahad 1, Ahmed Abdulkarim Sulaiman Alnughaymishi 1, Shalah Hmoud Al Harbi 1, Ahmed suhaiman Alsharari 1, Nasser Ali Alhabib 1, Soliman Mohammed Alehaidib 1, Omar Obaid Alharbi 1, Hussein Mohammed Alwadai 1, Adel lafi alharbi 1*
Journal of Angiotherapy 8(1) 1-10 https://doi.org/10.25163/angiotherapy.8110097
Submitted: 31 October 2023 Revised: 14 January 2024 Published: 15 January 2024
Abstract
Background: Epidural hematoma (EDH) is a life-threatening condition resulting from traumatic brain injury, often requiring prompt diagnosis and intervention to prevent irreversible neurological damage. Originating from arterial bleeding, EDH is characterized by the "lucid interval" phenomenon, emphasizing the need for vigilant clinical monitoring. Advances in imaging and a multidisciplinary approach have improved patient outcomes, yet challenges persist in timely management, particularly in patients with complicating factors such as anticoagulant use or advanced age. Methods: This review integrates recent findings on the pathophysiology, diagnosis, and management of EDH. A comprehensive literature search identified key studies on the contributions of emergency providers, pharmacists, and nurses to EDH care. Particular attention was given to the role of imaging modalities, pharmacological considerations, and post-operative monitoring in optimizing outcomes. Results: Emergency providers play a critical role in stabilizing patients and determining the need for surgical intervention. Imaging modalities, including CT and MRI, remain essential for diagnosis and assessing hematoma severity. Pharmacists contribute by managing anticoagulants and other medications, ensuring drug safety and preventing adverse interactions. Nurses are integral in continuous monitoring, early detection of complications, and patient education, enhancing recovery post-surgery. Multidisciplinary collaboration significantly reduces mortality and morbidity rates, particularly in high-risk populations such as the elderly or those on anticoagulation therapy. Conclusion: Timely recognition and intervention are paramount in the management of EDH. A coordinated effort between emergency providers, pharmacists, and nursing staff is essential to delivering effective care and improving outcomes. Future research should focus on refining management protocols, advancing imaging technologies, and exploring innovative therapeutic options to address unmet clinical needs in EDH care.
Keywords: Epidural hematoma, traumatic brain injury, multidisciplinary care, pharmacological management, surgical intervention
References
Aguilar, M. I., & Brott, T. G. (2011). Update in intracerebral hemorrhage. The Neurohospitalist, 1(3), 148–159. https://doi.org/10.1177/1941875211409050
Babu, J. M., Patel, S. A., Palumbo, M. A., & Daniels, A. H. (2019). Spinal emergencies in primary care practice. The American Journal of Medicine, 132(3), 300–306. https://doi.org/10.1016/j.amjmed.2018.10.027
Basamh, M., Robert, A., Lamoureux, J., Saluja, R. S., & Marcoux, J. (2016). Epidural hematoma treated conservatively: When to expect the worst. Canadian Journal of Neurological Sciences, 43(1), 74–81. https://doi.org/10.1017/cjn.2015.263
Bhorkar, N. M., Dhansura, T. S., Tarawade, U. B., & Mehta, S. S. (2018). Epidural hematoma: Vigilance beyond guidelines. Indian Journal of Critical Care Medicine, 22(7), 555–557. https://doi.org/10.4103/ijccm.IJCCM_130_18
Bonow, R. H., Barber, J., Temkin, N. R., Videtta, W., Rondina, C., Petroni, G., Lujan, S., Alanis, V., La Fuente, G., Lavadenz, A., Merida, R., Jibaja, M., Gonzáles, L., Falcao, A., Romero, R., Dikmen, S., Pridgeon, J., Chesnut, R. M., & Global Neurotrauma Research Group. (2018). The outcome of severe traumatic brain injury in Latin America. World Neurosurgery, 111, e82–e90. https://doi.org/10.1016/j.wneu.2017.11.071
Burjorjee, J. E., Rooney, R., & Jaeger, M. (2018). Epidural hematoma following cessation of a direct oral anticoagulant: A case report. Regional Anesthesia and Pain Medicine, 43(3), 313–316. https://doi.org/10.1097/AAP.0000000000000721
Chicote Álvarez, E., González Castro, A., Ortiz Lasa, M., Jiménez Alfonso, A., Escudero Acha, P., Rodríguez Borregán, J. C., Peñasco Martín, Y., & Dierssen Sotos, T. (2018). Epidemiology of traumatic brain injury in the elderly over a 25-year period. Revista Española de Anestesiología y Reanimación, 65(10), 546–551. https://doi.org/10.1016/j.redar.2018.07.009
Fernández-Abinader, J. A., González-Colón, K., Feliciano, C. E., & Mosquera-Soler, A. M. (2017). Traumatic brain injury profile of an elderly population in Puerto Rico. Puerto Rico Health Sciences Journal, 36(4), 237–239.
Flaherty, B. F., Moore, H. E., Riva-Cambrin, J., & Bratton, S. L. (2018). Repeat head CT for expectant management of traumatic epidural hematoma. Pediatrics, 142(3), e20180524. https://doi.org/10.1542/peds.2018-0524
Gutowski, P., Meier, U., Rohde, V., Lemcke, J., & von der Brelie, C. (2018). Clinical outcome of epidural hematoma treated surgically in the era of modern resuscitation and trauma care. World Neurosurgery, 118, e166–e174. https://doi.org/10.1016/j.wneu.2018.06.043
Jeong, Y. H., Oh, J. W., Cho, S., & Korean Trauma Data Bank System Committee. (2016). Clinical outcome of acute epidural hematoma in Korea: Preliminary report of 285 cases registered in the Korean Trauma Data Bank System. Korean Journal of Neurotrauma, 12(2), 47–54. https://doi.org/10.13004/kjnt.2016.12.2.47
Kanematsu, R., Hanakita, J., Takahashi, T., Park, S., & Minami, M. (2018). Radiologic features and clinical course of chronic spinal epidural hematoma: Report of 4 cases and literature review. World Neurosurgery, 120, 82–89. https://doi.org/10.1016/j.wneu.2018.07.103
Khairat, A., & Waseem, M. (2023). Epidural hematoma. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441993/
Rosenthal, A. A., Solomon, R. J., Eyerly-Webb, S. A., Sanchez, R., Lee, S. K., Kiffin, C., Davare, D. L., Hranjec, T., & Carrillo, E. H. (2017). Traumatic epidural hematoma: Patient characteristics and management. The American Surgeon, 83(11), e438–e440.
Tamburrelli, F. C., Meluzio, M. C., Masci, G., Perna, A., Burrofato, A., & Proietti, L. (2018). Etiopathogenesis of traumatic spinal epidural hematoma. Neurospine, 15(1), 101–107. https://doi.org/10.14245/ns.1836016.012
View Dimensions
View Altmetric
Save
Citation
View
Share