Abstract
Background:Children with epidural hematoma (EDH) present differently than adults. The outcome of treatment is also different. We aim to report our experiences with EDH in pediatric age group in terms of mode of injury, presenting features, management, and outcomes. We also aim to identify different prognostic indicators in pediatric patients with EDH.Methods:We prospectively collected data from 24 consecutively surgically treated pediatric patients. The data collected included presenting features, radiological imaging, details of management, and outcomes. Descriptive analysis was performed and different variables were tested for any statistical significance with Glasgow Outcome Score (GOS).Results:There were 19 male and 5 female patients. The mean Glasgow Coma Scale (GCS) score at presentation was 9.3 ± 4.4. Falls were the most common cause of EDH. Outcome assessment was done at 3 month follow up. A total of 15 patients had a GOS score of 5, 4 patients had a GOS score of 4, 2 patients had a GOS score of 3, while 3 patients had a GOS score of 1. On univariate analysis, admitting GCS score, patient's age, the time from injury to admission and injury to surgery, anisocoric pupils at presentation and effacement of basal cisterns were significantly associated with the outcome of GOS score.Conclusion:Falls are the most common mode of injury leading to EDH in children. Lower GCS at presentation, younger age at trauma, increased time since trauma to surgery and admission, anisocoria and effacement of basal cisterns are statistically significant variables in surgically treated pediatric patients of EDH that confer a poorer prognosis. A timely surgical intervention can result in excellent outcomes.
Highlights
Epidural hematoma (EDH) is a potentially life threatening complication of traumatic brain injury
As neurosurgeons in other developing countries would be faced with a similar situation, the aim of this study is to report our experiences with epidural hematoma (EDH) in the pediatric age group in terms of mode of injury, presenting features, management, and outcomes
We identify prognostic indicators in pediatric patients with EDH
Summary
Epidural hematoma (EDH) is a potentially life threatening complication of traumatic brain injury. The incidence of EDH has been reported between 1% and 6% of hospitalized patients following a traumatic brain injury.[5,8,14,24] Children with EDH are less likely to lose consciousness from the traumatic event and require immediate surgery less frequently They show a lower incidence of intradural hematomas compared with adults.[8,12] The incidence of associated skull base fractures is lower, the course is more insidious and the signs, symptoms, and outcomes are different from adults.[8,12,14] These make them difficult to diagnose and manage. We aim to identify different prognostic indicators in pediatric patients with EDH
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