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Although skull trephination is rarely performed and is no longer part of the core curriculum for emergency medicine, it might be lifesaving for patients with expanding epidural hematoma and evidence of rapid deterioration. In a retrospective review of a Minnesota hospital's trauma registry from 1990 to 2007, researchers identified patients with computed tomography–confirmed expanding epidural hematoma secondary to blunt trauma who had evidence of deterioration (decreasing mental status and anisocoria) despite medical therapy and who required interfacility transfer for neurosurgical care. The researchers compared outcomes between the five patients who underwent skull trephination in the ED and the two who did not.
Among patients who underwent…