Traumatic epidural hematomas in the pediatric population: clinical characteristics and diagnostic pitfalls

Abstract

Background/PurposeThe purpose of this study was to review the initial clinical presentation of EDH, identify potential clinical markers and highlight diagnostic pitfalls. MethodsRetrospective review of all pediatric patients admitted to a Level I Trauma Center diagnosed with blunt traumatic EDH from 2008 to 2018. ResultsA total of 699 pediatric patients were identified with blunt traumatic brain injury (TBI); 106 with EDH made up the study population. A skull fracture was present in 84%. Overall, the most common clinical finding was a scalp hematoma (86%), followed by loss of consciousness (66%), emesis (34%), headache (27%), amnesia (18%), and seizures (12%). Importantly, 40% of patients with EDH presented with GCS 15. Four children (4%) had GCS 15 and were completely asymptomatic on admission. In three children (3%) the only symptom was a scalp hematoma. 50% of all EDH required craniotomy, and this was not significantly different if GCS was 15 on presentation (45%, p = 0.192). Mortality was 2%. Fourteen patients (13%) were discharged with cognitive/motor deficits. ConclusionsPediatric EDH frequently present with subtle clinical signs, including a normal GCS half the time.Irrespective of asymptomatic presentation, threshold for CT scan or an observation period should be low after head injuries in children. Type of studyPrognosis study. Level of EvidenceLevel II/III.