Traumatic epidural hematomas in children and adolescents: outcome analysis in 39 consecutive unselected cases

Despite early diagnosis of traumatic epidural hematomas (EDHs) in children, mortality remained quite high in recent series. The aims of this analysis were to review the cause and outcome of pediatric EDH nowadays and to discuss outcome-related variables in a large consecutive series of surgically treated EDH in children.

This is a retrospective case series of 39 patients (27 males, 69%) with surgically treated EDH between June 1997 and February 2007. Patients' medical records, computed tomographic scans, and, if performed, magnetic resonance imagings were reviewed to define variables associated with outcome. Variables included in the analysis were age, associated severe extracranial injury, abnormal pupillary response, hematoma thickness, severity of head injury (Glasgow Coma Scale score < or = 8), parenchymal brain injury, and diffuse axonal injury. Long-term follow-up (mean [SD], 51.3 [27] months) was available in 38 patients, and outcomes were classified as excellent (modified Rankin Scale score [mRS], 0; Glasgow Outcome Scale score, 5) and good (mRS scores, 1 and 2; Glasgow Outcome Scale score, 4).

The mean (SD) age of the patients was 83.1 (59.9) months (range, 1-191 months). The mortality was zero, and the outcomes were excellent in 34 and good in 4 patients (one was lost to follow-up). Most of the injuries with EDH occurred in familial settings (23 cases), with falls being the most common mechanism of injury in 20 patients. Trauma was caused by traffic accidents in 14 cases (pedestrians hit by a motor vehicle, 7 cases; bicycle accidents, 5 cases; and motorbike and car accidents, 1 case each). One EDH occurred during delivery. The mean size of the EDH was 18.5 (12) mm (range, 5-40 mm). Three patients were referred with unilateral or bilateral dilated pupil(s). Except in 4 patients, all EDHs were associated with skull fracture(s) (90%). Computed tomography or magnetic resonance imaging revealed brain contusion in 13 patients, and 1 had diffuse axonal injury. None of the tested variables were found to have a prognostic relevance as tested by multivariate analysis (backward exclusion, Wald method).

Regardless of the EDH size, the clinical status of the patients, the abnormal pupillary findings, or the cause of injury, the outcome and prognosis of the patients with EDH are excellent.