Nonoperative management of epidural hematomas and subdural hematomas: is it safe in lesions measuring one centimeter or less?

BACKGROUND: Management of a patient with a closed head injury is based on neurologic status and computerized tomography scan results. We hypothesized that those patients with an epidural hematoma (EDH) or subdural hematoma (SDH) <1 cm in thickness could safely be treated nonoperatively.

METHODS: We retrospectively reviewed charts of 204 consecutive patients with either an EDH or SDH.

RESULTS: There were 122 lesions < or =1 cm and 82 lesions >1 cm. In the first group, 115 were managed nonoperatively, with 111 good outcomes (minimal deficit with a Rancho Los Amigos score [RLAS] > or =3), two poor outcomes (severely disabled with RLAS <3), and two deaths. Twenty-eight patients with lesions greater than 1 cm had concomitant cerebral edema (CE) with an 89% mortality rate. The mortality rate in this group without CE was 20%, demonstrating the presence of CE in this group may have adversely affected the mortality rate, regardless of intervention.

CONCLUSIONS: This data suggests that EDH or SDH <1 cm thick can be safely managed nonoperatively unless there is concomitant CE.