Introduction: Epidural hematomas (EDH) are a known and potentially lethal consequence of closed head injury. There are currently little objective data to assist clinicians in determining which patients with EDH can be safely observed and which require surgical intervention. As a result, operative rates for EDH in published case series range from 19 to 70%.
Methods: The trauma registry of a pediatric level two trauma center was queried for all cases of EDH between 2001 and 2010. The operative rate was calculated from the trauma registry for this cohort of cases. Charts for cases between 2006-2010 were then reviewed and the following variables were recorded: lowest GCS, occurrence of loss of consciousness, presence of any focal neurologic deficit, maximum EDH thickness, maximum midline shift, location of EDH, length of stay, and death. Bivariate analysis was conducted to determine predictors of surgery.
Results: Between 2001-2010, 48 cases of EDH were identified. 31 (60%) of the cases were treated with observation only. There were no deaths in either group. In the 2006-2010 cohort (27 patients( 48%) observed), significantly different characteristics between the observation and surgical groups were EDH thickness (10mm v 16m, p = 0.009), midline shift (0.2mm v 3.8mm, p = 0.007). Characteristics that were not significantly different were lowest GCS (13.6 v 10.5, p = 0.07) and presence of a focal neurologic deficit (0% vs 21%, P=.007). LOS was not different between groups (4 days vs 5.3 days, P=.19). The majority of EDH were located in the frontal or temporal regions; location did not appear to predict surgery.
Conclusions: Pediatric EDH was managed without surgery in the majority of our cases. Size of the bleed and the magnitude of the midline shift were more predictive of surgery than GCS.
Patient Care: Our study will help to further delineate clinical and radiological features that impact decision making in Neurosurgical management of the epidural hematoma in the pediatric population.
Learning Objectives: To describe operative rates for pediatric EDH over a 10 year period, and to describe differences in the radiographic and clinical features of patients with EDH treated with observation versus surgery.