Conservative Management for Epidural Hematoma

Monitoring Protocol

• The American College of Surgeons recommends performing neurological examinations at minimum every 4 hours initially, assessing GCS score, pupillary response, motor strength, and sensory function 1

Coagulation Management

• The American Heart Association recommends reversing anticoagulation immediately if present, with a target platelet count >100 × 10⁹/L before any potential surgical intervention, and correcting INR to <1.4 in warfarin-treated patients 2
• The American College of Chest Physicians suggests considering thromboprophylaxis only after hemostasis is secured and hematoma stability is confirmed on serial imaging 2

Absolute Indications for Surgical Conversion

• The American Academy of Neurology recommends surgical conversion for neurological deterioration of any degree, decreased level of consciousness, and development or worsening of focal neurological deficits 1, 3
• The Brain Injury Foundation recommends surgical intervention for increased intracranial pressure refractory to medical management, progressive increase in hematoma size on serial CT, and increasing mass effect or midline shift 1

Critical Pitfalls to Avoid

• The American Association of Neurological Surgeons advises against delaying surgical intervention if neurological deterioration occurs, as this leads to significantly worse outcomes 1