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Epidural hematoma in infants: a different entity?
L Beni-Adani1, I Flores, S Spektor
1Department of Neurosurgery, Hadassah University Hospital, Ein-Karem, Jerusalem, Israel. consts@netvision.net.il
Insights
Diagnosing epidural hematoma (EDH) in infants is challenging. A new Trauma Infant Neurologic Score, incorporating lateralizing signs and scalp injuries, is proposed for better assessment of infant neurotrauma.
Area of Science:
- Pediatric neurosurgery
- Trauma care
Background:
- Epidural hematoma (EDH) in infants presents unique diagnostic challenges compared to older children.
- Clinical presentation and injury mechanisms differ significantly in infants.
- Optimal prognostic tools and computed tomography (CT) guidelines for infant EDH are lacking.
Purpose of the Study:
- To characterize clinical and radiologic parameters of EDH in infants.
- To correlate these parameters with patient outcomes.
- To propose a novel neurotrauma scoring system for infants.
Main Methods:
- Eleven infants under 2 years old diagnosed with EDH and surgically treated were studied.
- Children's Glasgow Coma Scale (CCS) was applied for neurological assessment.
- Diagnosis was confirmed using computed tomography (CT).
Main Results:
- The average age of infants was 13 months; 63.6% fell from under 1 meter.
- Admission CCS scores averaged 10.7, with 45% unconscious and 18.2% having a perfect score.
- Lateralizing signs were present in 5 infants, pupillary abnormalities in 2, and subgaleal hematomas in 72.7%.
Conclusions:
- A new Trauma Infant Neurologic Score is suggested for managing EDH in infants.
- Objective parameters such as lateralizing signs, pupillary abnormalities, trauma mechanism, and scalp injuries should be included in the score.
Background:
Epidural hematoma (EDH) in infants may be difficult to diagnose. The mechanism of injury and the clinical presentation are different from those in older children. We characterized the clinical and radiologic parameters of EDH in infants and correlated them with outcome. Because there are no optimal prognostic tools or clear guidelines to perform computed tomography in this unique population, a new approach of neurotrauma scoring is suggested.
Methods:
Eleven infants (<2 years old) operated on for EDH were studied. Children's Glasgow Coma Scale (CCS) score was applied, and diagnosis was confirmed by computed tomography.
Results:
Age was 13+/-5 months. Seven infants (63.6%) fell from less than 1 m. CCS score on admission was 10.7+/-3.9. Five infants (45%) were unconscious, yet two (18.2%) had CCS scores of 15. Pupillary abnormalities were found in two infants and lateralizing signs in five infants. Eight infants (72.7%) had subgaleal hematomas. Mortality and morbidity were 9% each.
Conclusion:
We suggest that a Trauma Infant Neurologic Score be used when dealing with EDH in infants. Lateralizing signs, pupillary abnormalities, mechanism of trauma, and scalp injuries should be included because these are objective relevant parameters.