A 28-year-old victim of a road traffic accident has GCS 10 on arrival. CT brain shows a biconvex hyperdense collection with 8 mm midline shift and no herniation. The decision for surgery versus non-surgical management hinges on which combination of criteria per EAST/BTF guidelines?
- A GCS <12 regardless of CT findings
- B Haematoma volume >30 mL OR clot thickness >15 mm OR midline shift >5 mm ✓
- C Haematoma volume >50 mL and midline shift >10 mm
- D Any epidural haematoma in an unconscious patient requires immediate craniotomy
Explanation
Brain Trauma Foundation (BTF) guidelines for epidural haematoma (EDH) recommend surgical evacuation if: haematoma volume >30 mL regardless of GCS, clot thickness >15 mm, OR midline shift >5 mm. This patient has 8 mm midline shift meeting criteria for surgical evacuation. GCS alone does not determine surgery — a GCS >8 with EDH meeting volume/thickness/shift criteria still warrants craniotomy. The classic lucid interval followed by rapid deterioration is seen in only 30% of EDH cases. Temporal lobe EDH poses particular risk of transtentorial herniation due to proximity to uncus. Prompt evacuation is the key to good outcome in EDH.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.