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Updated: Mar 14, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Pediatric patients with traumatic epidural hematoma at low risk for deterioration and need for surgical treatment
Brian F Flaherty1, Hannah E Moore2, Jay Riva-Cambrin3
1University of Utah, Department of Pediatrics, Division of Critical Care, Salt Lake City, UT 84108.
Insights
Pediatric patients with small traumatic epidural hematoma (EDH) unlikely to fail observation have no mass effect, small bleed volume (<15ml), and no neurologic deficits. This prediction rule identifies low-risk patients for successful hospital observation.
Area of Science:
- Pediatric neurosurgery
- Trauma care
- Clinical prediction modeling
Background:
- Clinical practice for managing pediatric traumatic epidural hematoma (EDH) is variable.
- Some pediatric patients with small EDH are managed non-surgically, but criteria for successful observation are not well-defined.
Purpose of the Study:
- To develop a prediction rule for identifying pediatric patients with EDH who are unlikely to fail hospital observation.
- To establish criteria for safe non-operative management of traumatic EDH in children.
Main Methods:
- Retrospective review of pediatric patients with EDH managed non-operatively at a Level I trauma center (2003-2014).
- Comparison of clinical and radiographic features between patients who failed observation and those successfully managed.
- Development of a prediction rule based on key indicators.
Main Results:
- Of 222 pediatric patients with EDH observed, 196 (88%) were successfully managed.
- Factors predicting failure of observation included altered mental status, larger bleed thickness and volume, and presence of mass effect.
- A prediction rule of no mass effect, EDH volume <15ml, and no neurologic deficits identified patients at low risk of failure (PPV 98%).
Conclusions:
- Pediatric patients with traumatic EDH and no mass effect, a volume <15ml on CT, and no neurologic deficits are at low risk of failing non-operative management.
- This prediction rule can aid in selecting pediatric patients suitable for observation, potentially avoiding unnecessary surgery.
Background:
Although some pediatric patients with small traumatic epidural hematoma (EDH) are observed without surgical drainage, clinical practice remains variable.
Objectives:
Create a prediction rule to identify patients with EDH unlikely to fail hospital observation.
Methods:
Retrospective review at a level I pediatric trauma center between 2003 and 2014. Presenting clinical and radiographic features were compared between those successfully to failed observation.
Results:
Two hundred twenty-two patients with EDH whose initial management strategy was observation were analyzed; 196 (88%) were successfully observed. The group failing observation was more likely to present with altered mental status (RR 18.8; 95% CI 8.7-49.6), has larger median bleed thickness (observed = 5.6mm versus failed observation = 10.9mm, p<0.01), median bleed volume (observed = 2.1ml versus failed observation = 15.7ml, p<0.01), and mass effect (RR 3.7; 95% CI 1.8-7.7). No mass effect, EDH volume<15ml, and no neurologic deficits predicted patients at low risk of failing observation with a positive predictive value of 98% (95% CI 93-99%). There was no difference in median discharge Glasgow outcome scores (5 in both groups, p=0.20).
Conclusion:
Patients with no mass effect and EDH volume <15ml on initial CT scan and no neurologic deficit are at low risk of failing observation.
Level Of Evidence:
Retrospective cohort level I.
