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[Epidural hematoma in children. Prognostic factors. Analysis of 70 cases]
A Palomeque Rico1, J M Costa Clará, F J Cambra Lasaosa
1UCI Pediátrica, Unidad Integrada de Pediatría, H. Clínic-H.Sant Joan de Déu, Esplugues, Barcelona.
Insights
Epidural hematoma in children with head trauma is often associated with skull fractures. Multiple cerebral contusions, brain edema, low Glasgow Coma Scale scores, and shock predict poor outcomes.
Area of Science:
- Pediatric Neurosurgery
- Trauma Surgery
- Neurology
Context:
- Epidural hematoma (EDH) is a critical neurosurgical emergency, particularly in pediatric patients with cranioencephalic trauma.
- Understanding the incidence and prognostic factors of EDH is crucial for timely intervention and improved patient outcomes.
- This study retrospectively analyzes a cohort of pediatric patients diagnosed with EDH.
Purpose:
- To determine the incidence of epidural hematoma in pediatric cranioencephalic trauma.
- To identify clinical, radiological, and chronologic variables associated with epidural hematoma.
- To establish prognostic criteria for adverse outcomes in pediatric patients with epidural hematoma.
Summary:
- A retrospective analysis of 70 pediatric patients with epidural hematoma revealed that diagnosis occurred within the first four years in 63% of cases.
- Skull fractures (68%) and temporoparietal EDH (66%) were common radiological findings. Neurologic impairment was present on admission in only 33% of patients.
- While 63% of patients recovered fully, 23% experienced neurodisability, and 3% died. Factors like multiple cerebral contusions, brain edema, low GCS, and shock correlated with poor prognosis.
Impact:
- This research highlights key indicators for predicting outcomes in pediatric epidural hematoma, aiding in risk stratification.
- Findings can inform clinical decision-making and resource allocation in pediatric neurotrauma management.
- The study emphasizes the importance of early recognition of specific clinical and radiological signs for improved patient management and prognosis.
Objective:
The aim of this study was to analyze the causes of epidural hematoma in order to know its incidence in craneoencephalic trauma and establish prognostic criteria.
Patients And Methods:
A retrospective study of 70 children with the diagnosis of epidural hematoma between 1990 and 1995 were studied. Clinical, radiological, chronologic variables and evolution were analyzed.
Results:
The diagnosis was made during the first 4 years in 63% of the cases. Neurologic impairment was present at admission in only 33% of the patients. Ages ranged between 7 days and 17 years (mean age: 8 years). Of these patients, 82% were admitted to the PICU, 53% were ventilated and 19% needed ICP monitorization. Radiological findings on the first CT were skull fracture (68%) and temporoparietal epidural hematoma (66%), right-sided (63%). Other kinds of lesions were also recorded in the first and subsequent CTs. Three patients died, 63% recovered fully, 10% had serious sequelae and 23% had some degree of neurodisability.
Conclusions:
The following data correlated with death or neurological impairment: Multiple cerebral contusion (p = 0.002), brain edema (p = 0.05), GCS less than 8 on admission (p = 0.002), and shock (p = 0.003). On the other hand, neither surgical drainage volume, age, location of the hematoma, nor ICP values correlated with a poor prognosis.