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

Abstract

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.

Supratentorial extradural hematoma in children: An institutional clinical experience of 65 cases

“…In our study, it is found that most common presenting symptom was vomiting found in 80% ( n = 52) cases and next to it was altered sensorium found in 70.76% ( n = 46) which is not consistent with other literature like Chowdhury et al ,[ 1 ] Khan et al ,[ 2 ] Paiva et al ,[ 3 ] Jamjoom et al [ 6 ] Early posttraumatic seizure was found in only 5 (7.6%) cases which was too low as compared to Chowdhury et al [ 1 ] but high enough as compared to Khan et al [ 2 ] one case had presented with right-sided hemiparesis and one case had left facial nerve paresis. Pupillary abnormality like bilateral dilated pupil with sluggish reaction to light was found in 2 cases.…”

“…Fall from height was the most common mode of injury found in 44.4% ( n = 29), followed by RTA 35.35% ( n = 23) in our series is comparable with many series studies. [ 1 2 6 8 ]…”

“…Our mortality rate is consistent with reported mortality rate by Chowdhury et al ,[ 1 ] but higher than other literature. [ 7 2 10 ] Mortality ranged in between 0% and 12% with zero mortality described by some literature. [ 10 ] It was also found that 4 out of 5 deaths were admitted with GCS <6 and 4 deaths were postoperative.…”

“…Extradural hematoma (EDH) is one of the life-threatening intracranial pathologies resulting in significant mortality and morbidity in the pediatric population. [ 1 2 3 ] Without any visible scalp injury, it can be of significant amount needing neurosurgical care though associated scalp hematoma is a common finding among young children. The EDH is rare among the children below 2 years.…”

“…The peak incidence of pediatric EDH among all head injury has been reported to be in the range of 2.7–4%. [ 2 ] In spite of improved diagnostic methods and increased number of skilled neurosurgeons, the mortality and morbidity become unavoidable in some cases due to delayed presentation and delay in diagnosis. In this retrospective study, we tried to find out and analyze different clinical presentation, mechanism of injury, and epidemiological parameters to help in the suspicion and early management of pediatric EDH.…”