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Published on: October 15, 2021
Predictive Factors for Delayed Surgical Intervention in Children With Epidural Hematomas
Insights
In children with traumatic epidural hematomas (EDHs) admitted for observation, larger hematomas, mass effect, headaches, and prolonged prothrombin times predict delayed surgery. Further research is needed to confirm these findings.
Area of Science:
- Pediatric Neurosurgery
- Trauma Surgery
- Neurology
Background:
- Optimal treatment for pediatric traumatic intracranial epidural hematomas (EDHs) remains unclear.
- Identifying predictors for delayed surgical intervention in observed pediatric EDH cases is crucial.
Purpose of the Study:
- To identify clinical and radiographic predictors of delayed surgical intervention in children with traumatic EDH who were admitted for observation.
Main Methods:
- Retrospective review of 103 pediatric patients (under 15 years) with acute traumatic EDHs.
- Exclusion of penetrating injuries, prior surgery, or depressed skull fractures.
- Classification into immediate surgery, supportive-therapy-only, or delayed surgery groups based on intervention.
Main Results:
- Larger EDH size (thickness ≥1.1 cm, volume ≥14 mL), mass effect, headaches, and prothrombin time >14 seconds were associated with delayed surgery.
- No significant differences in length of stay or functional impairment between immediate and delayed surgery groups.
- Delayed surgery group had more subjective symptoms at discharge.
Conclusions:
- Larger EDH, mass effect, headaches, and elevated prothrombin time predict delayed surgical intervention in observed pediatric EDH cases.
- A larger study is recommended to identify independent predictors for delayed surgery in this population.
Background:
Optimal treatment of children with traumatic intracranial epidural hematomas (EDHs) is unknown. We sought to identify clinical and radiographic predictors of delayed surgical intervention among children with EDH admitted for observation.
Methods:
We retrospectively identified patients younger than 15 years with acute traumatic EDHs evaluated at our level 1 pediatric trauma center. We excluded patients with penetrating head injuries, recent surgical evacuation of EDH, or depressed skull fracture requiring surgical repair and assigned the remaining subjects to the immediate surgery group if they underwent immediate surgical evacuation, to the supportive-therapy-only group if they underwent observation only, and to the delayed surgery group if they underwent surgery after observation. We abstracted clinical and laboratory findings, surgical interventions, and neurological outcome and measured EDH dimensions and volumes, adjusting for cranial size. We compared clinical and radiographic characteristics among groups and performed receiver-operator characteristic analyses of predictors of delayed surgery.
Results:
Of 172 patients with EDH, 103 patients met the inclusion criteria, with 6 (6%) in the immediate surgery group, 87 (84%) in the supportive-therapy-only group, and 10 (10%) in the delayed surgery group. Headache, prothrombin time of >14 seconds, EDH maximal thickness of ≥1.1 cm, volume of ≥14 mL, EDH thickness/cranial width index of ≥0.08 and EDH volume/cranial volume index of ≥0.18, and mass effect were associated with delayed surgical intervention. There was no difference in length of stay or functional impairment between the immediate and delayed surgery groups. However, patients in delayed surgery group were more likely to have subjective symptoms at discharge than those in immediate surgery group.
Conclusions:
Among patients with EDH admitted for observation, larger EDH, mass effect, headaches, and prothrombin time of >14 seconds were associated with delayed surgical intervention. A larger-scale study is warranted to identify independent predictors of delayed surgery in children under observation for EDH.
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