Traumatic Acute Epidural Hematoma in Children

Abstract

Objective: The aim of this study is to investigate the clinical characteristics of acute epidural hematoma (AEDH) in children and to report our experience in recent years. Methods: A series of 48 patients below the age of 15 years treated for AEDH at our institution between August 1999 and August 2008 was analyzed in detail. All patients were divided into three groups according to age to identify any age-dependent clinical characteristics. Group A comprised 7 infants aged 0 to 3 years, group B 28 children aged 4 to 9 years, and group C 13 children aged 10 to 15 years. We reviewed retrospectively medical records and analyzed clinical status and radiological findings including age, causes of injury, initial Glasgow coma scale (GCS) or Modified GCS, location of hematoma, conservative or surgical treatment, and Glasgow outcome scale (GOS). Results: Thirty-two patients were male and 16 patients were female. The most frequent cause of trauma was pedestrian car accident, followed by fall, and slip. Initial GCS was mild (13-15) in 39 children, moderate (9-12) in 5, and severe head trauma (3-8) in 4. The location of the hematoma was frontal in 11 children, parieto-occipital in 23, temporal in 8, and posterior cranial fossa in 6. There was statistically significant correlation between initial GCS and GOS (p<0.05). Conclusion: Pediatric AEDH presents both age related and atypical features when compared with AEDH in adults. In selected cases, prompt surgical evacuation of the hematoma results in an excellent outcome. Operative treatment of AEDH has few difficulties for a surgeon with neurosurgical training. The outcome was found to be predominantly affected by the initial neurological status. (J Kor Neurotraumatol Soc 2009;5:11-15)