Supratentorial epidural hematoma of traumatic etiology in infants

Ciurea, Alexandru Vlad; Kapsalaki, Eftychia; Coman, Teodora Camelia; Roberts, John L.; Robinson, Joe Sam; Taşcu, A.; Brehar, Felix Mircea; Fountas, Kostas N.

doi:10.1007/s00381-006-0230-4

Cited by 38 publications

(45 citation statements)

References 26 publications

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“…This finding is in concordance with a study from Stockholm, which reported that falls were the predominant cause in children and even more often in younger children [13]. For infancy EDH, it has been widely shown that falls contribute most of the causes of injury [8,9]. Also for nonfatal unintentional head injuries, falls have been reported to be the leading cause in the infant population [14].…”

Section: Discussionsupporting

confidence: 88%

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Trauma Infant Neurologic Score Predicts the Outcome of Traumatic Brain Injury in Infants

et al. 2010

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To investigate the clinical features of infancy traumatic brain injury (TBI) and the prognostic value of the Trauma Infant Neurologic Score (TINS), infants <2 years of age with TBI who were admitted from 2000 to 2007 were retrospectively studied. Fifty-six patients with a mean age of 13.3 ± 6.5 months (range = 2–24) were identified. The clinical diagnoses, in terms of the severest injury, included scalp hematomas (n = 2), skull bone fractures (n = 3), epidural hematomas (n = 21), subdural hematomas (n = 14), cerebral contusion and laceration (n = 4), intracerebral hematomas (n = 7), traumatic subarachnoid hemorrhage (n = 2), diffuse axonal injury (n = 2) and diffuse brain swelling (n = 1). The most common clinical presentations were vomiting (66.1%), paleness (55.4%), irritability (37.3%), pupillary abnormalities (35.7%) and altered consciousness (32.1%). The mechanism of injury included falls (n = 41), vehicle accident (n = 9), abuse (n = 4) and unknown (n = 2). The TINS score ranged from 1 to 10 with a mean of 3.6 (SD = 2.4) in the whole patient cohort. The Children’s Coma Scores (CCS) on admission were 13–15 (n = 31), 9–12 (n = 7) and 3–8 (n = 18). Thirty-nine of the infants were operated on and the other 17 infants were treated nonsurgically. Forty-eight patients (86%) were followed up for a period of 1–8 years (mean = 4.4) after discharge. In the followed-up patient cohort, the mean TINS score at admission was 3.8 ± 2.5. The total clinical outcome, according to the Glasgow Outcome Scale (GOS), was: 37 (77.1%) good recovery, 4 (8.3%) moderately disabled, 1 (2.1%) vegetative and 6 (12.5%) dead. For those who were operated on the outcome was: 25 (78.1%) good recovery, 4 (12.5%) moderately disabled and 3 (9.4%) dead, and for those who were not operated on: 12 (75.0%) good recovery, 1 (6.3%) vegetative and 3 (25.0%) dead. At two years of follow-up, the GOS included 34 (73.9%) good recovery, 3 (6.5%) moderately disabled, 2 (4.3%) severely disabled, 1 (2.2%) vegetative and 6 (13.0%) dead. Statistical tests revealed that the TINS scores were highly associated with the GOS. Higher TINS scores resulted in worse clinical outcome. The CCS scores were also to some degree associated with the GOS score. However, the CCS score on admission was not as discriminating as TINS, predicting only the best and worst outcome in our series. Our study showed that the clinical features of TBI in infants were different from those seen in adults regarding both the distribution of the pathology type and the clinical presenting symptoms. We found that the TINS scoring system is useful for predicting prognosis and outcome in infancy TBI and suggest that it could be routinely used in the infantile population.

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Section: Discussionsupporting

confidence: 88%

“…Beni-Adani’s [8] preliminary data suggested that TINS is useful for selecting patients for head CT scan and prediction of prognosis in infants with epidural hematoma (EDH). In concordance with Beni-Adani’s [8] report, a recent study on infants showed that patients who died of EDH had high TINS scores upon admission [9]. …”

Section: Introductionsupporting

confidence: 79%

Trauma Infant Neurologic Score Predicts the Outcome of Traumatic Brain Injury in Infants

et al. 2010

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“…Furthermore, the criteria for utilizing surgical evacuation vs conservative management have remained ill-defined. Thus, the lack of any guideline regarding the appropriate management of EDH in pediatric patients and particularly in infants makes the management of this specific group of patients all the more complicated (10).…”

Section: Khaled Chowdhury Smn Et Al: Extradural Haematoma In Childrenmentioning

confidence: 99%

“…It has been estimated that EDH represents 2-3% of all head injuries in the pediatric population (10). The mean age of pediatric patients harboring EDH is between 6 and 10 years and it is even rarer among infants under the age of 12 months (3,7,10,28).…”

Section: Introductionmentioning

confidence: 99%

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

Km²,

Mahmood³

et al. 2011

Turkish Neurosurgery

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AIm: We present our experiences in the management of extradural haematoma in children which involved an aggressive diagnostic approach, prompt surgical evacuation results in an excellent outcome. mAterIAl and methOds: 170 EDH patients who underwent surgery in our department from January 2006 to July 2010 included in this prospective study. Each patient evaluated in term of age, sex, mode of injury, localization of haematoma, clinical presentation, CT findings, operative measures and outcome.results: Out of 170 cases 72%, (n=122) were boys and 28 %,( n=48) were girls. The boys to girls ratio was 2.54: 1. Age ranged from 1.8 to 18 years with a mean age of 9.49 years. Most of the victims are in the 11-18 years age group 44% ( n=74). The most common mode of injury was fall 41%, (n = 70) followed by Road traffic Accident (RTA) 32%, (n = 54) .The most common clinical presentation was altered sensorium 61 %, (n= 104), followed by headache and/or vomiting 56 %, (n = 96). The mortality rate was 8%.COnClusIOn: EDH is recognized as one of the most rewarding neurosurgical emergencies. It must be diagnosed in the early period of the trauma and evacuated early to prevent potential mortality and morbidity. Different factors affect the outcome of extradural haematoma Surgery including age of the patient, presence of cranial fractures, associated brain lesions and pre-operative neurological condition of patient, duration of time interval between onset of coma and surgical intervention. Better prognosis is seen in patients less than 10 years of age. sOnuÇ: Beyin cerrahisi acil yaklaşımları içerisinde en yüzgüldürücü sonuçları olan patolojilerden birisi de ekstradural hematomlardır. Bu tür hematomlar travmanın erken döneminde tanınmalı ve cerrahi tedavisi mortalite ve morbiditeyi önlemek için en hızlı şekilde yapılmalıdır. Ekstradural hematomların cerrahi sonuçları değişik faktörler tarafından etkilenmektedir; bunlar, hastanın yaşı, kranial kemik kırıklarının olması, beyinde ek lezyonların olması, hastanın ameliyat öncesi klinik durumu ve hastanın komaya giriş süresi ile ameliyata alınış süresi arasında geçen süre gibi etkenler sayılabilir. Yaşı 10'dan küçük olan hastaların prognozu daha iyi olmaktadır.

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“…Recently, due to the pronounced increase in the number of patients who undergo brain CT scans following minor head injuries, we noticed profound changes in the clinical features of children with traumatic EDH, resulting in a greater proportion of EDH detected in patients who are still conscious and neurologically intact or with minimal symptoms [2, 3]. The aim of this study is to report the outcome after nonsurgical management in those children who remain in good clinical condition.…”

Section: Introductionmentioning

confidence: 99%

Conservative Management of Acute Epidural Hematoma in a Pediatric Age Group

et al. 2009

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Objective: Craniotomy and evacuation is the standard treatment of acute epidural hematoma (EDH). Here, the authors report their experience in nonoperative management of acute EDH in children with mild head injury. Methods: The authors retrospectively reviewed charts of patients with conservatively treated EDH at the Department of Neurosurgery, King Abdulla University Hospital, Irbid, Jordan, between August 2003 and October 2007. All patients had a Glasgow Coma Scale score of 14 or 15, and an initial computerized tomography (CT) scan demonstrating an EDH with or without skull fractures. Follow-up included neurological examination and brain CT. Results: Six children (3 boys, 3 girls) with acute EDH were successfully managed at our department without surgical intervention. The Glasgow Outcome Scale score of all patients was 5, with no posttraumatic sequelae. Follow-up brain CT showed complete resolution of the EDH within 2–3 months. Conclusions: Our results demonstrated that pediatric EDH can be managed nonoperatively. The pronounced increase in the number of CT examinations for patients with head injuries has resulted in a greater proportion of EDH detected in conscious patients. We recommend such treatment be performed in specialized pediatric neurosurgical centers under close neurological observation.

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Supratentorial epidural hematoma of traumatic etiology in infants

Cited by 38 publications

References 26 publications

Trauma Infant Neurologic Score Predicts the Outcome of Traumatic Brain Injury in Infants

Trauma Infant Neurologic Score Predicts the Outcome of Traumatic Brain Injury in Infants

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

Conservative Management of Acute Epidural Hematoma in a Pediatric Age Group

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