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

Abraham, Ron Ben; Lahat, Eli; Sheinman, Guy; Feldman, Zeev; Barzilai, Asher; Harel, Ran; Barzilay, Zohar; Paret, Gideon

doi:10.1159/000028990

Cited by 22 publications

(23 citation statements)

References 19 publications

(16 reference statements)

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“…Previous studies reported that a younger age is correlated with a worse outcome in pediatric head trauma patients [16,17,18]. In our study, we also found that younger age is correlated with an unfavorable outcome.…”

Section: Discussionsupporting

confidence: 86%

The Surgical Outcome of Traumatic Extra-Axial Hematomas Causing Brain Herniation in Children

et al. 2013

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Aim: The aim of this study was to assess the surgical outcome and prognostic importance of clinical and radiological data from children operated on under emergency conditions due to an extra-axial hematoma causing brain herniation. Methods: This retrospective study included 25 children operated on due to herniated traumatic extra-axial hematomas from January 2000 to December 2010. Results: Of those 25 children, 17 (68%) were diagnosed with subdural hematoma (SDH), 7 (28%) with epidural hematoma (EDH) and only 1 patient (4%) suffered from both SDH and EDH. Overall mortality from a herniated extra-axial hematoma was 44%. The mortality rate for herniated SDH patients was 52.9%, and only 1 patient died from a herniated EDH (14.2%). Low Glasgow coma scale scores at admission, high postoperative intracranial pressure (ICP) values, longer intervals from trauma to surgery, longer durations of brain herniation, the presence of intraoperative brain swelling, larger and thicker hematomas and more displacement of the midline structures and obliteration of the basal cisterns were all correlated with mortality and an unfavorable outcome. Conclusions: Brain herniation is a serious consequence of traumatic extra-axial hematomas in children, and approximately one third of these patients have the potential for a favorable outcome. We recommend postoperative ICP monitoring to predict outcome and early decompressive surgery when possible for promising results.

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Section: Discussionsupporting

confidence: 86%

The Surgical Outcome of Traumatic Extra-Axial Hematomas Causing Brain Herniation in Children

et al. 2013

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“…These are similar to those in adults3). But, mortality of EDH in children is lower than that of adult10).…”

Section: Discussionsupporting

confidence: 77%

“…The approximated mortality is 5%, although mortality in the quoted literature ranges from 0% to 12%, and was even higher in the pre-CT era3,5,11).…”

Section: Discussionmentioning

confidence: 98%

Our Experience with Surgically Treated Epidural Hematomas in Children

Jung

Kim

2012

J Korean Neurosurg Soc

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ObjectiveTraumatic epidural hematomas (EDHs) in children are a relatively unusual occurrence. The cause and outcome vary depending on period and region of study. The aims of this analysis were to review the cause and outcome of pediatric EDHs nowadays and to discuss outcome-related variables in a large consecutive series of surgically treated EDH in children.MethodsThis is a retrospective review of 29 patients with surgically treated EDHs between Jan 2000 and February 2010. Patients' medical records, computed tomographic (CT) scans, and, if performed, magnetic resonance imaging (MRI) were reviewed to define variables associated with outcome. Variables included in the analysis were age, associated severe extracranial injury, abnormal pupillary response, hematoma thickness, severity of head injury (Glasgow Coma Scale score), parenchymal brain injury, and diffuse axonal injury.ResultsThe mean (SD) age of the patients was 109 months (0-185 months). Most of the injuries with EDHs occurred in traffic accident (14 cases, 48.2%) and followed by slip down in 6 cases and falls in 6 cases. There were one birth injury and one unknown cause. EDHs in traffic accidents occurred in pedestrians hit by a motor vehicle, 9 cases; motorbike and car accidents, 5 cases and bicycle accidents, 1 case. The locations of hematoma were almost same in both sides (left side in 15 cases). Temporal lobe is the most common site of hematomas (13 cases, 44%). The mean size of the EDHs was 18 mm (range, 5-40 mm). Heterogeneous hematomas in CT scans were 20 cases (67%). Two patients were referred with unilateral or bilateral dilated pupil(s). There was enlargement of EDH in 5 patients (17%). All of them were heterogeneous hematomas in CT scans. Except for 4 patients, all EDHs were associated with skull fracture(s) (87%). There was no case of patient with major organ injury. CT or MRI revealed brain contusion in 5 patients, and diffuse axonal injury in one patient. The mortality was zero, and the outcomes were excellent in 26 and good in 2 patients. None of the tested variables were found to have a prognostic relevance.ConclusionRegardless of the EDH size, the clinical status of the patients, the abnormal pupillary findings, or the cause of injury, the outcome and prognosis of the patients with EDH were excellent.

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“…Elsewhere in the literature falls have been reported as the most common mode of head trauma leading to EDH in children while road traffic accidents are the most common mode in adults. [38111214] Thus there is a significant difference in mechanism of injury among children and adults.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of traumatic extra dural hematoma in children: Experiences and analysis from 24 consecutively treated patients in a developing country

Khan¹,

Riaz²,

Javed³

et al. 2013

Surg Neurol Int

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Background:Children with epidural hematoma (EDH) present differently than adults. The outcome of treatment is also different. We aim to report our experiences with EDH in pediatric age group in terms of mode of injury, presenting features, management, and outcomes. We also aim to identify different prognostic indicators in pediatric patients with EDH.Methods:We prospectively collected data from 24 consecutively surgically treated pediatric patients. The data collected included presenting features, radiological imaging, details of management, and outcomes. Descriptive analysis was performed and different variables were tested for any statistical significance with Glasgow Outcome Score (GOS).Results:There were 19 male and 5 female patients. The mean Glasgow Coma Scale (GCS) score at presentation was 9.3 ± 4.4. Falls were the most common cause of EDH. Outcome assessment was done at 3 month follow up. A total of 15 patients had a GOS score of 5, 4 patients had a GOS score of 4, 2 patients had a GOS score of 3, while 3 patients had a GOS score of 1. On univariate analysis, admitting GCS score, patient's age, the time from injury to admission and injury to surgery, anisocoric pupils at presentation and effacement of basal cisterns were significantly associated with the outcome of GOS score.Conclusion:Falls are the most common mode of injury leading to EDH in children. Lower GCS at presentation, younger age at trauma, increased time since trauma to surgery and admission, anisocoria and effacement of basal cisterns are statistically significant variables in surgically treated pediatric patients of EDH that confer a poorer prognosis. A timely surgical intervention can result in excellent outcomes.

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

Cited by 22 publications

References 19 publications

The Surgical Outcome of Traumatic Extra-Axial Hematomas Causing Brain Herniation in Children

The Surgical Outcome of Traumatic Extra-Axial Hematomas Causing Brain Herniation in Children

Our Experience with Surgically Treated Epidural Hematomas in Children

Surgical management of traumatic extra dural hematoma in children: Experiences and analysis from 24 consecutively treated patients in a developing country

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