Epidural hematomas in children

Schutzman, Sara A.; Barnes, Patrick D.; Mantello, Michael T.; Scott, R. Michael

doi:10.1016/s0196-0644(05)81938-9

Cited by 60 publications

(15 citation statements)

References 13 publications

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“…Similar results were reported in other series of pediatric AEH [1, 3]. These data demonstrate that, in the pediatric age group, even a relatively low kinetic energy trauma can cause AEH.…”

Section: Discussionsupporting

confidence: 91%

“…A lucid interval was defined as a period of time after the injury and before the diagnosis in which the child displayed full awareness. The time of diagnosis was considered to be the time at which the CT scan was performed, and the findings at diagnosis were those noted on the emergency room evaluation form at the time of diagnosis [1]. …”

Section: Methodsmentioning

confidence: 99%

“…Patients were categorized as having bradycardia or tachycardia if heart rates were documented below or above the respective age-appropriate normal range, at any one time prior to surgery or hospital admission [1]. Hypertension or hypotension was considered as being present if blood pressure above the 95th percentile or below the 5th percentile for respective age was recorded at any time before surgery or hospital admission.…”

Section: Methodsmentioning

confidence: 99%

“…Although the introduction of CT has improved the accuracy of diagnosis, early diagnosis depends on astute clinical observations [1]. Children with AEH who are admitted to well-equipped pediatric intensive care units are subjected to a plethora of clinical, laboratory and imaging procedures.…”

Section: Introductionmentioning

confidence: 99%

“…Children with AEH who are admitted to well-equipped pediatric intensive care units are subjected to a plethora of clinical, laboratory and imaging procedures. However, few studies have investigated the correlation between these test results on admission and the child’s prognosis in terms of neurological outcome [1, 2, 3, 4]. The present study was undertaken to review our 11-year experience with 61 consecutive children with AEH and sought to delineate early indicators prognostic of outcome in a defined subset of pediatric patients who sustained these injuries.…”

Section: Introductionmentioning

confidence: 99%

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Metabolic and Clinical Markers of Prognosis in the Era of CT Imaging in Children with Acute Epidural Hematomas

Abraham

Lahat²,

Sheinman³

et al. 2000

Pediatr Neurosurg

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Acute epidural hematoma (AEH), a relatively common complication of head injury in children, persists in bearing high morbidity and mortality. Early establishment of prognosis could guide optimal patient allocation, and early identification of predictive signs could assist in choosing appropriate therapeutic interventions. This study aimed to delineate expeditiously obtainable prognostic markers for determining outcome in a subset of children with AEH. We reviewed our 11-year experience with 61 consecutive children <16 years old with head trauma and isolated AEH. Treatment followed a standard advanced trauma life support protocol. A medical history was obtained, and all patients underwent neurosurgical and physical evaluations. CT scans were performed, as were laboratory tests which included arterial blood gases, glucose, electrolytes (K⁺, Na⁺), hemoglobin and coagulation studies. Evaluation of the data collected on cause of injury, interval between trauma occurrence and presentation, clinical symptoms, Glasgow Coma Scale (GCS) scores, vital signs, laboratory test results, physical findings and surgical versus conservative management revealed that the best single predictors of outcome following AEH were the GCS and focal neurological deficits. Of all laboratory data obtained on admission, the blood potassium, pH and glucose test results correlated significantly with prognosis. Prognosis can be adequately and expeditiously estimated by selected markers within a comprehensive evaluation of children with AEH.

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“…Similar results were reported in other series of pediatric AEH [1, 3]. These data demonstrate that, in the pediatric age group, even a relatively low kinetic energy trauma can cause AEH.…”

Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Metabolic and Clinical Markers of Prognosis in the Era of CT Imaging in Children with Acute Epidural Hematomas

Abraham

Lahat²,

Sheinman³

et al. 2000

Pediatr Neurosurg

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Head Trauma in Children Younger Than 2 Years

Gruskin¹,

Schutzman²

1999

Arch Pediatr Adolesc Med

110

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To determine the incidence of skull fracture (SF) and intracranial injury (ICA) among children younger than 2 years evaluated in a pediatric emergency department for head trauma; whether historical features and/or physical findings are predictive of injury type; and whether clinical criteria could allow a selective approach to radiographic imaging.Design: Retrospective medical record review.Setting: Tertiary pediatric emergency department.Patients: Case series of 278 children aged younger than 24 months evaluated for head injury.Main Outcome Measures: Presence of SF and/or ICA.Results: Diagnoses at discharge included 227 minor head injuries, 39 isolated SF, 9 ICA with SF, and 3 isolated ICA. Children younger than 12 months had the highest incidence of SF/ICA (29%) vs 4% for children aged 13 to 24 months (PϽ.001). Seven percent of complications from SF/ICA resulted from falls 3 ft (0.9 m) or less. Incidence of behavioral change, loss of consciousness, emesis, and seizures did not differ significantly between those with minor head injuries and those with SF/ICA. Scalp abnormalities were more common in children with SF/ ICA (PϽ.001). Sixty-two percent of children with isolated SF and 58% of children with ICA had no history of loss of consciousness, emesis, seizure, or behavioral change. Ninety-two percent of children with isolated SF and 75% of children with ICA had normal levels of consciousness and nonfocal neurologic examinations at diagnosis. Among children who fell 3 ft (0.9 m) or less and had no loss of consciousness, emesis, seizure, behavioral change, or scalp abnormality, none of 31 (95% confidence interval [CI], 0-0.10) children younger than 24 months and none of 20 (95% CI, 0-0.15) children younger than 12 months had SF/ICA.Conclusions: Both SF and ICA are common in children younger than 2 years evaluated for head trauma. Children younger than 12 months are at highest risk. Injuries resulted from relatively minor falls and occurred in alert, neurologically normal children. Clinical signs and symptoms were insensitive predictors of SF/ICA; however, a grouping of features (fall Յ3 ft [0.9 m], no history of neurologic symptoms, and normal scalp physical examination results) identified a subset of children at low risk for complications.

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