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Extradural hematomas in children

G Maggi1, F Aliberti, G Petrone

  • 1Neurosurgical Division, Santobono Children's Hospital, Naples, Italy.

Journal of Neurosurgical Sciences
|November 25, 1998
PubMed
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Extradural hematomas in children, often from minor head injuries, require careful management. Key indicators like skull fractures, loss of consciousness, and vomiting suggest potential intracranial complications needing prompt evaluation.

Area of Science:

  • Pediatric Neurosurgery
  • Trauma Surgery
  • Pediatric Neurology

Background:

  • Extradural hematomas are rare but significant complications of pediatric head injuries, frequently resulting from minor trauma.
  • Management of these injuries remains controversial, especially in asymptomatic cases where intracranial bleeding is detected via CT scans.

Purpose of the Study:

  • To identify clinical and diagnostic parameters predicting intracranial complications in pediatric patients with head trauma.
  • To analyze the relationship between injury mechanisms, clinical presentation, and outcomes in children with epidural hematomas.

Main Methods:

  • A retrospective study of 61 pediatric patients (5 months to 12 years) operated on for epidural hematomas between 1991 and 1995.
  • Patients were categorized into three age groups; data collected included mechanism of injury, clinical findings, neurological assessment, hematoma location, and presence of skull fracture.

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Main Results:

  • Accidental falls were the most common cause of head trauma in younger children, while accidents involving bicycles, pedestrians, and cars predominated in older children.
  • Skull fractures were present in 49 cases. Recurrent vomiting occurred in approximately 70% of cases, and loss of consciousness was frequent (78%) in older children.
  • Patient outcomes were primarily dependent on the Glasgow or Children's Coma Scale score upon admission, with an overall mortality rate of 4.9%.

Conclusions:

  • Localized skull trauma, suspected fractures, loss of consciousness, and recurrent vomiting are significant indicators for potential intracranial complications in pediatric head injuries.
  • These findings support the need for vigilant monitoring and diagnostic imaging in children presenting with these symptoms after head trauma.