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Published on: October 15, 2021
Complete Neurological Recovery After Emergency Burr Hole Placement Utilizing EZ-IO® for Epidural Hematoma
Marc Grossman1, Alfred P See2, Rebekya Mannix3
1Department of Emergency Medicine, Parkland Medical Center, Derry, New Hampshire.
Insights
Emergency physicians can use the EZ-IO device for temporizing treatment of pediatric epidural hematoma (EDH) when neurosurgical services are unavailable. This intervention may be lifesaving, improving outcomes in critical head injury cases.
Area of Science:
- Emergency medicine
- Neurosurgery
- Pediatric trauma
Background:
- Post-traumatic epidural hematoma (EDH) is a serious condition, accounting for 1-3% of pediatric head injuries.
- Mortality rates for EDH are 10% in adults and 5% in children.
- Standard treatment involves decompressive craniotomy, typically performed by neurosurgery teams.
Observation:
- A 17-year-old female with EDH following a motor vehicle collision presented to an ED lacking neurosurgical services.
- The patient required intubation and experienced transport delays due to weather.
- Decompression and drainage of EDH were achieved using an EZ-IO device under virtual neurosurgical guidance.
Findings:
- The EZ-IO device served as a temporizing intervention for EDH in a resource-limited setting.
- The patient made a full neurologic recovery.
Implications:
- The EZ-IO device offers a potential lifesaving option for EDH management when definitive neurosurgical care is inaccessible.
- Emergency physicians should be aware of this technique in remote or underserved areas.
- This approach may reduce morbidity and mortality associated with EDH.
Background:
Post-traumatic epidural hematoma (EDH) accounts for 1-3% of pediatric closed head injury admissions. There is a 2.5:1 male predominance. Etiology varies by age; motor vehicle collisions are the primary cause of EDH in adolescents. Post-traumatic EDH accompanies up to 4% of adult head injuries, and is associated with 10% mortality in adults and 5% mortality in children. In North America, standard of care for post-traumatic EDH includes decompressive craniotomy or trepanation via burr hole. Such lifesaving care is typically provided in the operating room by consulting neurosurgery teams or other personnel trained in the use of burr hole equipment.
Case Report:
The case of a 17-year-old female patient who presented to a community emergency department (ED) after being involved in a motor vehicle collision is discussed. At the scene of the accident, she refused emergency medical services transport and was brought to the ED via private vehicle. She quickly decompensated in the ED and required intubation. Neurosurgical services were not available and transport to the nearest pediatric trauma center was delayed due to weather. Decompression and drainage of her EDH was accomplished with an EZ-IO® driver and intraosseous needle under virtual guidance of a pediatric neurosurgeon until definitive care could be obtained. The patient made a full neurologic recovery.
Why Should An Emergency Physician Be Aware Of This:
EDHs have high morbidity and mortality. In settings without access to neurosurgical services, and where ED access to or familiarity with burr hole equipment is limited, the EZ-IO® device may be a temporizing and lifesaving intervention until definitive neurosurgical care can be obtained.
