Predictive Factors for Delayed Surgical Intervention in Children With Epidural Hematomas

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.