Acute traumatic subdural effusion with hemorrhage in children under 3 years of age： a study of clinical characteristics and treatment strategy

Abstract

Purpose Acute traumatic subdural effusion with hemorrhage (ATSEH) is a common type of head trauma in children. However, there is considerable variation in the previous literature regarding the clinical presentation, pathogenesis, and treatment strategies of ATSEH in children. The purpose of this study was to summarize the clinical features of ATSEH in children as well as to explore their treatment strategies. Methods There were 79 cases of ATSEH studied retrospectively at a pediatric teaching hospital over an 7-year period. The children ranged in age from 1 month to 3 years, with an average age of 8.51(4.33,11.00) months. We analyzed the relationship between the outcome of ATSEH treatment and factors such as age, sex, symptoms, signs, coagulation function, internal environmental homeostasis, and imaging materials. The mean follow-up time was 57.56(34,82) months. The mRS score was used for patient prognosis. Results 27 out of 79 (34.2%) children showed subtle findings. Impaired consciousness was observed in 26.4% of patients. 52 out of 79 (65.8%) children presented with overt neurological symptoms and signs, with vomiting was t the most common symptom. 51 of 79 children (64.6%) presented with increased fontanelle tone. 32 out of 79 (40.51%) patients required operative management. 73 of the 79 patients (92.4%) had a good prognosis. The patients in the surgical group showed reduced fibrinogen (<1.5g/L) in 53.1%, low hemoglobin (88.56±17.21) and hyponatremia (133.50±3.76). Conclusions Patients with an age of 9.07(4.31,8.30) presenting with increased impairment of consciousness and increased anterior fontanelle tone are the basis for surgical treatment. Through the treatment of patients with ATSEH, we have found that the essence of ATSEH is an impairment of cerebrospinal fluid circulation triggered by subdural hemorrhage, which leads to acute hydrocephalus. In patients with ATSEH with malignant cranial hypertension, the timely subdural drainage is the key to treating and reducing serious complications. Prevention and correction of hypofibrinogen and hyponatremia are important aspects of the treatment of ATSEH in children that cannot be ignored.