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Clinico-radiological Correlation with Outcome in Traumatic Pediatric Extradural Hematoma: A Single Institutional
Shivender Sobti1, Manuranjan Goyari2, Raghavendra Harpanahalli3
1Department of Neurosurgery, Dayanand Medical College & Hospital, Ludhiana.
Insights
Pediatric extradural hematoma (EDH) is rare but serious. This study of 38 children found prompt diagnosis and intervention are key to reducing negative outcomes in pediatric head injuries.
Area of Science:
- Pediatric Neurosurgery
- Trauma Surgery
- Pediatric Critical Care
Background:
- Head injury is a significant cause of mortality and morbidity globally.
- Extradural hematoma (EDH) accounts for 1-2% of head injuries, and is less common in children (1-3% of pediatric head injuries).
- The pediatric dura mater's tight adherence to the skull contributes to the infrequency of EDH in this age group.
Purpose of the Study:
- To analyze the characteristics, presentation, and outcomes of traumatic extradural hematoma in children.
- To highlight the importance of early diagnosis and management in pediatric head trauma.
Main Methods:
- Prospective study of 38 pediatric patients (<18 years) with traumatic EDH over 19 months.
- Follow-up included clinical assessments and Non-contrast computed tomography (NCCT) head scans at baseline, during neurological changes, and postoperatively.
- Glasgow Outcome Scale (GOS) was used for outcome assessment.
Main Results:
- The majority of patients (55.26%) were aged 1-5 years, with falls from height being the most common cause.
- Loss of consciousness was the most frequent symptom (78.94%). The parietal region was the most common EDH location (44.74%).
- No mortality was observed; two patients experienced limb paresis. Six patients required surgical intervention.
Conclusions:
- Pediatric extradural hematoma, though rare, is a critical condition requiring immediate attention.
- Timely diagnosis and intervention are crucial for improving outcomes and reducing mortality in pediatric head injury patients.
Background:
Head injury is one of the leading causes of mortality and morbidity in the developing as well as developed countries. Extradural hematoma is seen in 1-2% of cases of head injury patients. Extradural hematoma is infrequent in the pediatric age group (less than 18 years) as duramater is tightly adherent to the inner table of the skull and is present in about 1-3% of all pediatric head injuries.
Materials And Methods:
The study was a prospective study conducted in the Department of Neurosurgery at PGIMER, Dr. RML Hospital, New Delhi, over a period of 19 months with a follow-up of 6 months. In total, 38 patients were enrolled in the study. All traumatic extradural hematoma below 18 years of age of both sexes were included. Follow-up of all patients was done at 2 weeks, 1, 2, and 6 months. Noncontrast computed tomography (NCCT) head was done in all patients at the time of admission and whenever their neurological status deteriorated. Routine postoperative NCCT head was done. Outcome assessment was done by Glasgow outcome scale.
Results:
Of the 38 children, 21 were males and 17 were females. The maximum number of patients was between the ages of 1-5 years (55.26%). Fall from height was the most common cause. Loss of consciousness was the most common presenting symptom (78.94%). Thirty-three patients had GCS of 14-15 at the time of presentation. The parietal region was the most common location of EDH in our study (44.74%). Thirty-five patients had supratentorial and three patients had infratentorial EDH. Eighteen patients had associated brain injury, commonest being brain edema. Six patients were operated. There was no mortality in our study. Two patients had limb paresis.
Conclusion:
Pediatric EDH is a rare entity but a potentially life-threatening condition. Prompt diagnosis and timely intervention decrease morbidity and mortality.
