Traumatic epidural hematomas in the pediatric population: clinical characteristics and diagnostic pitfalls
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Read the article on jpedsurg.org ↗Article · Jun 2020 · 1 min read
In brief
In brief
This retrospective study of 106 pediatric epidural hematoma cases reveals that 40% presented with normal Glasgow Coma Scale scores and some were completely asymptomatic, yet half still required craniotomy. The findings emphasize maintaining a low threshold for CT imaging in pediatric head injuries regardless of initial presentation.
Written by the GCMD Library team from the article.
Background/Purpose
The purpose of this study was to review the initial clinical presentation of EDH, identify potential clinical markers and highlight diagnostic pitfalls.
Methods
Retrospective review of all pediatric patients admitted to a Level I Trauma Center diagnosed with blunt traumatic EDH from 2008 to 2018.
Results
A total of 699 pediatric patients were identified with blunt traumatic brain injury (TBI); 106 with EDH made up the study population. A skull fracture was present in 84%. Overall, the most common clinical finding was a scalp hematoma (86%), followed by loss of consciousness (66%), emesis (34%), headache (27%), amnesia (18%), and seizures (12%). Importantly, 40% of patients with EDH presented with GCS 15. Four children (4%) had GCS 15 and were completely asymptomatic on admission. In three children (3%) the only symptom was a scalp hematoma. 50% of all EDH required craniotomy, and this was not significantly different if GCS was 15 on presentation (45%, p = 0.192). Mortality was 2%. Fourteen patients (13%) were discharged with cognitive/motor deficits.
Conclusions
Pediatric EDH frequently present with subtle clinical signs, including a normal GCS half the time.
Irrespective of asymptomatic presentation, threshold for CT scan or an observation period should be low after head injuries in children.
Type of study
Prognosis study.
Level of Evidence
Level II/III.