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Risk factors for bad outcome in pediatric epidural hematomas: a systemic review
Peter Spazzapan1, Klemen Krašovec1, Tomaž Velnar1
1Unit of Pediatric Neurosurgery, Department of Neurosurgery, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia.
Insights
Pediatric epidural hematomas (EDH) often have excellent outcomes with appropriate treatment. A low Glasgow Coma Scale (GCS) score upon admission is the main predictor of potential neurological deficits in children with EDH.
Area of Science:
- Pediatric Neurosurgery
- Traumatic Brain Injury Management
Background:
- Pediatric epidural hematomas (EDH) are critical neurosurgical emergencies.
- Both surgical and conservative management strategies can yield favorable clinical outcomes.
- Identifying factors influencing pediatric EDH outcomes is crucial for treatment planning.
Purpose of the Study:
- To review a series of pediatric EDH cases.
- To determine clinical and radiologic factors impacting patient outcomes.
- To evaluate the effectiveness of different treatment approaches for pediatric EDH.
Main Methods:
- Retrospective review of pediatric patients (0-16 years) treated for cranial EDH between 2013 and 2017.
- Analysis of treatment strategies: surgical evacuation versus conservative management.
- Assessment of clinical outcomes at 6 months post-trauma using the modified Rankin Scale (mRS).
Main Results:
- Thirty pediatric patients with EDH were included in the study.
- Excellent outcomes (mRS 0) were achieved in 83.3% of cases at 6 months.
- A Glasgow Coma Scale (GCS) score below 8 at admission was significantly associated with the presence of neurological deficits (p=0.048).
Conclusions:
- Pediatric epidural hematomas can be effectively managed, leading to excellent outcomes.
- A well-chosen treatment strategy is key to good recovery, even with severe initial conditions.
- Low GCS scores on admission are the primary indicator for potential long-term neurological sequelae in pediatric EDH.
Background:
Pediatric epidural hematomas (EDH) represent a neurosurgical emergency. Both surgical and conservative treatment can lead to a good clinical outcome. The aim of the study was to review our series of pediatric EDH and to determine the clinical and radiologic factors, which can influence the final outcome.
Methods:
All children aged from 0 to 16 that have been treated between 2013 and 2017 for cranial EDH have been selected.
Results:
Thirty children have been included in the study. Seventeen cases have been treated with surgical evacuation and 13 conservatively. Six months after the trauma, the outcome was excellent (mRS 0) in 25/30 (83.3%) cases, mild deficits (mRS 1-2) were present in 4/30 (13.3%), and severe deficits (mRS 3-5) in 1/30 (3.3%) cases. Only a GCS (Glasgow Coma Scale) below 8 at admission was significantly related to the presence of a neurologic deficit at 6 months (p = 0.048).
Conclusions:
EDH can be managed with excellent outcomes. Even in the presence of bad initial clinical and radiologic conditions, a correct treatment strategy can lead to a good recovery. In our series, only a GCS below 8 at admission was significantly related to the presence of neurological sequelae.
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