• Keisuke Sugi, Jin Kikuchi, Munetake Yoshitomi, Kimihiko Orito, Sosho Kajiwara, Yukihiko Nakamura, Nobuyuki Takeshige, Yasuharu Takeuchi, Toshi Abe, and Motohiro Morioka.
• Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan.
• World Neurosurg. 2024 Sep 1; 189: e674e680e674-e680.

BackgroundHematoma expansion (H-Ex) in small-/medium-sized acute epidural hematoma (AEDH) cases upon emergency admission is critical. Predicting H-Ex can lead to early surgical interventions, improving outcomes, and eliminating the need to check for expansion via computed tomography (CT). This study aimed to identify the most reliable predictors of AEDH expansion.MethodsWe retrospectively collected data from patients with pure AEDH not requiring surgical treatment upon emergency admission from 2012 to 2022. We assessed clinical and laboratory data, time from injury to the first CT, and time to follow-up CT. Factors predictive of H-Ex on the second follow-up CT, including the leakage sign (LS), were analyzed.ResultsA total of 23 patients with pure AEDH without surgery at admission were included, and LS was positive in 18. Thirteen patients showed H-Ex. The H-Ex group showed a significantly higher rate of positive LS and a lower mean platelet count than the group without H-Ex. LS's predictive value for AEDH expansion showed 100% sensitivity and 50% specificity. All patients with negative LS and normal platelet counts showed no H-Ex. Analyzing the time from injury to the first CT suggested that LS (+) within 120 minutes strongly predicted H-Ex. Reconstructed three-dimensional images of the leakage point on the skull revealed multiple mottled bleeding points on the dural surface.ConclusionsLS can predict H-Ex in patients with pure AEDH for whom emergency surgery is unnecessary at admission. The time from injury and platelet counts must also be considered.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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