Extradural haematoma. An analysis of two 8-year series at Groote Schuur Hospital.

Between 1954 and 1961 85 patients were operated on at Groote Schuur Hospital (GSH) for extradural haematomas and between 1968 and 1975 84 operations for this condition were performed. The 169 patients included 22 children; they had a mortality rate of 4,5% (1 death) compared with the 18,9% mortality for the combined total. There were 19 males to each female. The ratio of White to Coloured to Black patients was 3:8:5. Forty-eight per cent of extradural haematomas resulted from assaults, 24% from road traffic accidents and 28% from other injuries; these figures did not differ significantly in the two series. Among the 72 patients operated on within 24 hours of injury the mortality rate was 26,4%, whereas among the 97 operated on later the rate was significantly better--13,4%. The most significant feature was the difference in outcome for the 97 patients admitted direct to the neurosurgical unit at GSH, of whom 12,4% died, compared with 21 transferred from suburban hospitals, where the mortality rate was 33,3%, and the 51 patients sent from rural hospitals, of whom 25,5% died. Although neuroradiological methods are the most reliable means of localizing intracranial haematomas, the advantages gained may be outweighed by the urgency with which decompression is required. This means that the staff of rural and suburban hospitals must be trained to carry out diagnostic burr-holes followed by craniotomy if it should be necessary.