Extradural Hematoma in Children: Case Series of 33 Patients

Abstract

BACKGROUND: Conservative management of extradural hematomas (EDH) is relatively recent in the literature and there are few papers reporting on the pediatric population. OBJECTIVE: We conduct a 20-month assessment of the treatment administered for EDH at a pediatric intensive care unit (PICU). METHODS: A retrospective case series in the period described above. The main variables studied were the weight and age of the patients, the Pediatric Trauma Score, the mechanism of injury, clinical features, CT findings and the Glasgow Coma Scale score on arrival, and after 12 and 24 h. Also analyzed was whether during primary care either surgical intervention or initial conservative management was recommended. RESULTS: In the 20 months analyzed, 33 EDH patients were admitted to the PICU. Patients had a mean age of 7.42 ± 4.66 years, mean weight of 31.16 ± 16.16 kg and mean Pediatric Trauma Scores of 7.03 ± 3.71. Out of the total sample, surgery was indicated in 12 patients (36.4%) in primary care and 21 patients (63.6%) were treated with initial conservative management. Most of the patients who were given conservative treatment had a Glasgow Coma Scale score of 15 on arrival and maintained this level throughout the hospital stay. The most prevalent sites of the hematomas were the temporal and parietal regions and the most common associated injury was skull fracture. CONCLUSION: In this case series, conservative treatment of EDH was most frequent; however, which factors are involved in this decision has to be better studied.