Acute extradural haematoma in the elderly

The world's population of persons over 65 years of age (elderly) is increasing. Acute extradural haematoma (AEDH) in the elderly is rare. There has not been a publication dedicated solely to the evaluation of AEDH in the elderly. We undertook this study in order to establish a clinical profile in this important subgroup. It took the form of a retrospective evaluation of the in-patient charts of elderly patients with AEDH, performed over a 23-year period (1983-2005) at a single institution. Of 3249 patients with AEDH, 32 (<1%) were defined as elderly. Assault was the commonest causative factor (56%), followed by falls (25%) and motor vehicle accidents (19%). Eight patients died (25% mortality). Only a third of patients, (34%) made a good outcome, the majority of these were assault victims. No patient in coma, or over 75 years made a good outcome. The prognosis of elderly patients with AEDH is poor. Conservative treatment for comatose patients and the over 75s is justified.