Extradural haematomas in children: A 10-year review

Abstract

Extradural haematomas are a significant consequence of head injuries in children. The aim of this study was to evaluate the demographics, symptoms and signs, management and outcome of patients less than 18 years of age with extradural haematomas in our unit. We also specifically looked at repeat imaging performed, indications for this and its effect on further management. No previous reviews have included this. Fifty-six patients were identified from 01/01/1997 to 01/01/2007 for inclusion in this study. Their imaging was then reviewed as were the case notes. Of the patients studied, 70% were male. The average age was 10 years and 2 months with an average length of stay of one week. The commonest mechanisms of injury were a fall from height and an accident involving a bike. Presenting symptoms were documented in 40% of cases. 32% of patients had associated skull fractures. Six patients had other injuries, including long bone fractures and maxillofacial injuries. Glasgow Coma Scale was generally better on admission than pre-operatively and post-operatively was generally better than prior to surgery. Eight patients had neurological signs on admission, 11 had pre-operatively, and nine had post-operatively. 71% underwent a craniotomy with evacuation of the haematoma. Complications were reported in 16% with no mortality. 66% were seen in a neurosurgical clinic, with 46% seen in a Paediatric Head Injury Clinic after discharge. 66% had further imaging after their initial scan of which 52% had no clinical indication. Eight patients were operated on following re-imaging. Most extradural haematomas in children are caused by falls or vehicle accidents. The majority are treated surgically and do well. Indications for further scanning are often not present and in most, management is unchanged. The follow up of these patients also appears to be suboptimal.

Extradural haematoma in children: surgical experiences and prospective analysis of 170 cases

“…Only 5% of the victims were infants. These data is correlated with other reported series of EDH in children (9,12,14,21,24). This is due to the high-velocity trauma mechanism in the older age group (27).…”

“…The rate and type of associated extracranial injuries (32%) in our series is higher than in the study by Duthie et al (12). 5% of children in their study had associated extracranial injuries.…”

Is the presence of a linear fracture a predictor of delayed posterior fossa epidural hematoma?

“…Two DPFEDHs showed bilateral and 2 showed unilateral localization. Mean PFEDH volume was 13.5 cm 3 (range: 2.3-45 cm 3 ).…”

“…PFDEH accounts for 0.3% of all intracranial hematomas and 4-12% of all epidural hematomas (EDHs). [1][2][3][4][5][6] PFDEH usually develops secondary to trauma to the occipital, suboccipital, and retromastoid regions. Though clinical progression is slow, neurological progression is rapid and fatal in the absence of timely intervention.…”

Ocorrência de traumatismo raquidiano em doentes em coma decorrente de traumatismo cranioencefálico

“…O sacro corresponde à fusão das cinco vértebras sacrais. As articulações das vértebras lombares permitem flexão ou extensão de cerca de 85°, inclinação lateral de 30° e rotação de 10° (Cristante e Jorge, 2012;Howard, 2001;Rosi, 2011 (Baldo et al, 2003;Cristante e Jorge, 2012;Gabella et al, 1997;Hiller et al, 1997;Hoge et al, 2008;Holly et al, 2002;Howard, 2001;Kattail et al, 2009;Keita et al, 2010;Li et al, 2009;Lutaka et al, 2012;Marcon et al, 2012;Martins et al, 1998;Masson et al, 2001;Mulligan et al, 2010;Nujaimin et al, 2009;Pedram et al, 2010;Song e Lee, 2008;Teixeira et al,1999 (Duthie et al, 2009;Kiboi e Mriithi, 2009;Rosi, 2011;Teixeira et al, 1999).…”