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Epidural hematomas in children
S A Schutzman1, P D Barnes, M Mantello
1Division of Emergency Medicine, Children's Hospital, Boston, Massachusetts.
Insights
Traumatic epidural hematoma in children can result from minor head injuries and may present in alert individuals. Early diagnosis and management are crucial for favorable outcomes, minimizing long-term neurologic sequelae.
Area of Science:
- Pediatric Neurosurgery
- Trauma Care
- Neurology
Background:
- Traumatic epidural hematomas (EDH) in children are a significant concern.
- Understanding their presentation and outcomes is vital for effective management.
Purpose of the Study:
- To detail the clinical presentation, treatment strategies, and patient outcomes for pediatric traumatic epidural hematoma.
- To identify factors influencing the prognosis of children with traumatic EDH.
Main Methods:
- A retrospective chart review was conducted.
- The study included 53 children diagnosed with traumatic EDH via computed tomography scan between 1980 and 1990.
Main Results:
- Epidural hematoma occurred after minor falls in 24 of 53 children.
- Most children (51/53) presented with symptoms like vomiting, headache, or lethargy.
- All patients survived; 45 had normal examinations at discharge, with only mild persistent abnormalities in four at follow-up.
Conclusions:
- Pediatric traumatic EDH can arise from mild head trauma and may occur in alert children.
- Neurologic sequelae were more common with abnormal examinations or depressed mental status at diagnosis.
- Improved outcomes may be linked to earlier diagnosis via CT scans and a higher incidence of less severe trauma.
Study Objective:
To describe the presentation, management, and outcome of children with traumatic epidural hematoma.
Design:
Retrospective chart review.
Type Of Participants:
Fifty-three children diagnosed with traumatic epidural hematoma on computed tomography scan who were treated at Children's Hospital in Boston between 1980 and 1990.
Main Results:
Twenty-four of 53 children developed an epidural hematoma after a fall of less than 5 ft. At the time of diagnosis, 51 of 53 children had one or more symptoms of vomiting, headache, or lethargy. Twenty-six patients were alert, 21 were responsive to verbal or painful stimuli, and five were unresponsive or posturing. Twenty-one (40%) had acute neurologic deterioration before surgery; however, 20 (38%) were alert with normal vital signs and neurologic examinations at diagnosis. All patients survived, and at the time of discharge 45 had normal examinations and eight had neurologic abnormalities; at follow-up only four of these eight had persistent (although mild) abnormalities.
Conclusions:
Although often dramatic in presentation, epidural hematoma may occur after relatively minor head trauma and in alert children with nonfocal neurologic examinations. In our study, incidence of neurologic sequelae increased if abnormal neurologic examination or depressed mental status was present at diagnosis. The outcome of children in this study is improved from that of previous studies, perhaps due to increased use of computed tomography and higher incidence of low- or moderate-impact trauma in this series.