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Extradural hematomas in children
G Maggi1, F Aliberti, G Petrone
1Neurosurgical Division, Santobono Children's Hospital, Naples, Italy.
Insights
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.
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.
Background:
Extradural hematomas are rate complications of head injures in children often resulting from minor head traumas. Therefore the management of these ordinary traumas remains controversy since in many asymptomatic cases the intracranial bleeding is detected only by CT scan.
Methods:
During the study period between January 1991 and September 1995 sixty-one patients ranging in age from 5 months to 12 years were operated on for epidural hematomas. They represent about the 3% of all patients admitted for head injury in the same period in our Division. According to the age, children were divided in three groups (G1, G2, G3). Males predominate over females in each group of age. The mechanism of injury, the clinical findings, the neurological assessment on admission, the site of hematoma and the presence of skull fracture were examined in order to identify clinical and diagnostic parameters predicting developing intracranial complications.
Results:
The most common cause of head trauma was accidental falls in children under 5 years of age. Otherwise bicycle, pedestrian and car accidents are the main type of injury in older patients. A skull fracture was identified in 49 cases with a homogeneous distribution among the groups of age. Recurrent vomiting was found in about 70% of cases. A loss of consciousness was frequently reported (78%) in older children. Outcome mainly depended on Glasgow or Children Coma Score on admission. In our series the overall mortality rate was 4.9%.
Conclusions:
Our data according with the literature suggest that localized skull traumas, suspected fractures, a loss of consciousness after trauma and recurrent vomiting can be recommended as indications for intracranial complications.