Background In traumatic brain injury (TBI) patients, the time from trauma to cranial surgery is always of great concern to patients and neurosurgeons.

Patients and Methods A retrospective study conducted on 93 TBI patients presented with Glasgow Coma Scale from 4 to 13 and were operated for large volume (≥ 40 cm3) extradural hematoma (EDH) from July 2020 to December 2022. Surgery was done either within 6 hours following trauma (group A) or later than 6 hours (group B). We evaluated the impact of time from injury to surgery on postoperative clinical recovery, survival, and hospital stay.

Results Fifty patients (53.8%) were operated upon within 6 hours after trauma and 43 patients (46.2%) had operations later than 6 hours. No significant difference was found between the two study groups regarding any of the preoperative clinical or radiological factors except for the mean time from injury to surgery (p < 0.001). Delayed surgery > 6 hours was significantly associated with higher postoperative mortality (p = 0.014). Hospital stay was significantly shorter in patients operated ≤ 6 hours (p = 0.006). Patients operated ≤ 6 hours showed significantly favorable functional recovery both at discharge (p = 0.010) and after 1 month of follow-up (p = 0.023).

Conclusion Timely surgical intervention for large volume traumatic EDH is the gold standard. Early surgery “within 6 hours from trauma” not only can save patients' life but also is significantly associated with postoperative favorable clinical recovery, low morbidity, and short hospital stay.

A retrospective study conducted on 93 traumatic brain injury patients presented with Glasgow Coma Scale from 4 to 13 and were operated upon in our department for large volume (≥40 cm3) extradural hematomas from July 2020 to December 2022. Surgery was done either within the first 6 hours following trauma (group A) or later than 6 hours (group B). Our objective was to evaluate the impact of time from injury to surgery on postoperative clinical recovery, complications, survival, and hospital stay in head injury patients operated for large volume extradural hematomas.

This study was performed in the Department of Neurosurgery, Faculty of Medicine, Menoufia University Hospital, Shibin Elkom, Egypt.

All authors made a significant contribution to the work reported, whether that was in the conception; study design; execution; and acquisition, analysis, and interpretation of data. All authors took part in drafting, revising, and final approval of the article. This article has been read and approved by all authors and all agreed to be accountable for all aspects of the work.

All data and materials included in this work are available.

This study was approved by the clinical research committee of the Faculty of Medicine, Menoufia University (IRB approval number: 4-2023.NEUS. 4-1) and it followed the tenets of the Declaration of Helsinki.

Article published online:
04 June 2024

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