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Traumatic epidural hematomas in the pediatric population: clinical characteristics and diagnostic pitfalls
Camilla Cremonini1, Meghan Lewis1, Monica Darlene Wong1
1Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA 90033, USA.
Insights
Pediatric epidural hematomas (EDH) often present subtly, with normal Glasgow Coma Scale scores in half of cases. A low threshold for imaging is crucial after pediatric head injuries.
Area of Science:
- Pediatric Traumatology
- Neurocritical Care
- Emergency Medicine
Background:
- Epidural hematomas (EDH) are a significant concern in pediatric head injuries.
- Understanding the initial clinical presentation is key for timely diagnosis and management.
Purpose of the Study:
- To review the initial clinical presentation of pediatric epidural hematomas (EDH).
- To identify potential clinical markers for EDH.
- To highlight diagnostic pitfalls in pediatric head trauma.
Main Methods:
- Retrospective review of pediatric patients with blunt traumatic EDH.
- Data collected from a Level I Trauma Center between 2008 and 2018.
- Analysis of clinical findings, Glasgow Coma Scale (GCS) scores, and outcomes.
Main Results:
- 106 pediatric patients with blunt traumatic EDH were identified.
- 84% had a skull fracture; 86% presented with a scalp hematoma.
- 40% of EDH patients had a GCS of 15; 4% were asymptomatic.
- 50% required craniotomy; 13% had long-term deficits; 2% mortality.
Conclusions:
- Pediatric EDH frequently present with subtle signs, including normal GCS scores.
- A low threshold for CT scans or observation is recommended after pediatric head injuries.
- Early recognition and intervention are critical for improved outcomes in pediatric EDH.
Background/Purpose:
The purpose of this study was to review the initial clinical presentation of EDH, identify potential clinical markers and highlight diagnostic pitfalls.
Methods:
Retrospective review of all pediatric patients admitted to a Level I Trauma Center diagnosed with blunt traumatic EDH from 2008 to 2018.
Results:
A total of 699 pediatric patients were identified with blunt traumatic brain injury (TBI); 106 with EDH made up the study population. A skull fracture was present in 84%. Overall, the most common clinical finding was a scalp hematoma (86%), followed by loss of consciousness (66%), emesis (34%), headache (27%), amnesia (18%), and seizures (12%). Importantly, 40% of patients with EDH presented with GCS 15. Four children (4%) had GCS 15 and were completely asymptomatic on admission. In three children (3%) the only symptom was a scalp hematoma. 50% of all EDH required craniotomy, and this was not significantly different if GCS was 15 on presentation (45%, p = 0.192). Mortality was 2%. Fourteen patients (13%) were discharged with cognitive/motor deficits.
Conclusions:
Pediatric EDH frequently present with subtle clinical signs, including a normal GCS half the time. Irrespective of asymptomatic presentation, threshold for CT scan or an observation period should be low after head injuries in children.
Type Of Study:
Prognosis study.
Level Of Evidence:
Level II/III.
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