Prognostic factors for early functional outcome in patients with epidural hematoma

Abstract

Objective Epidural hematoma (EDH) is an important manifestation of traumatic brain injury (TBI), yet most evidence originates from high-income countries. This study evaluated prognostic factors and the association between surgical timing and early functional outcome in EDH patients treated in a resource-limited setting. Methods In this retrospective single-center study, adult EDH patients admitted to a tertiary hospital between 2011 and 2022 were analyzed. Clinical and radiological data were retrospectively collected. Early functional outcome was assessed using the Glasgow Outcome Scale Extended (GOSE) at discharge. Factors associated with unfavorable outcome were evaluated using uni- and multivariable logistic regression. Results Among 225 patients, interpersonal violence (62.2%) was the predominant injury mechanism. Most patients presented with mild TBI (51.1%), and 85.3% achieved a favorable outcome at discharge. Increasing age, abnormal pupillary status, and greater TBI severity were associated with unfavorable outcome in univariable analysis. In multivariable models adjusting for age and TBI severity, neither injury-to-surgery nor admission-to-surgery time was independently associated with outcome. TBI severity remained significantly associated with outcome, with severe TBI conferring approximately fivefold higher odds of unfavorable outcome compared with mild TBI. Conclusion TBI severity was the principal independent clinical factor associated with early functional outcome, whereas surgical timing was not independently associated with outcome after adjustment. Crude differences in surgical timing should therefore be interpreted in the context of severity-driven clinical prioritization rather than as evidence that surgical delay is beneficial.