Title

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

Document Type

Article

Department

Medical College Pakistan

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.