A prognostic scoring system for operated acute epidural hematoma based on gray–white matter ratio

To determine the prognostic risk factors of patients with acute epidural hematoma (AEDH), a scoring system was established based on gray–white matter ratio (GWR) and internal verification was performed. All patients with AEDH who underwent surgical treatment in Qinghai Provincial People's Hospital from January 2013 to June 2019 were continuously collected. The clinical and imaging data of the patients were collected. According to Glasgow Outcome Scale at 3 months after operation, the patients were divided into poor and good prognosis groups, respectively. The GWR value of the nonhematoma side was measured at the inner capsule area. Univariate and multivariate analyses were used. Independent predictors significantly related to the prognosis of AEDH were screened out and a nomogram was established based on these factors. A total of 170 cases were included in this study, the Glasgow Coma Score (severe and moderate), cerebral hernia, midline shift, preoperative GWR, postoperative GWR, hematoma thickness/midline shift, time from coma to surgery, and decompression of bone flap were the independent risk factors for predicting the poor prognosis of AEDH. Moreover, the prediction ability of nomogram was higher than any other independent predictive factors. The nomogram model established represents the most effective factor to predict the prognosis of operated AEDH. The scoring system is characterized by high accuracy, simplicity and feasibility, with a wide range of clinical application prospects.