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Predictive Factors for Delayed Surgical Intervention in Children With Epidural Hematomas.

Naomi Abe, Michael Gardiner, Christopher Dory

    Pediatric Emergency Care
    |February 2, 2023
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    Summary

    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.

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    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.