Traumatic Acute Epidural Hematoma in Children

Duck Hyung Ahn; Ki Seong Eom; Dae Won Kim; Jong Tae Park; Seong Keun Moon; Sung Don Kang; Tae Young Kim

doi:10.13004/jknts.2009.5.1.11

Journal List > J Korean Neurotraumatol Soc > v.5(1) > 1084040

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Ahn, Eom, Kim, Park, Moon, Kang, and Kim: Traumatic Acute Epidural Hematoma in Children

Clinical Article

Journal of Korean Neurotraumatology Society 2009; 5(1): 11-15.

Published online: 30 June 2009

DOI: https://doi.org/10.13004/jknts.2009.5.1.11

Traumatic Acute Epidural Hematoma in Children

Duck Hyung Ahn, MD, Ki Seong Eom, MD, Dae Won Kim, MD, Jong Tae Park, MD, Seong Keun Moon, MD, Sung Don Kang, MD, Tae Young Kim, MD

Department of Neurosurgery, Wonkwnag University College of Medicine, Iksan, Korea.

Address for correspondence: Ki Seong Eom, MD. Department of Neurosurgery, Wonkwang University College of Medicine, 344-2 Sinyong-dong, Iksan 570-749, Korea. Tel: +82-63-859-1461, Fax: +82-63-852-2606, kseom@wonkwang.ac.kr

Received 31 March 2009 Revised 18 May 2009 Accepted 18 May 2009

Abstract

Objective

The aim of this study is to investigate the clinical characteristics of acute epidural hematoma (AEDH) in children and to report our experience in recent years.

Methods

A series of 48 patients below the age of 15 years treated for AEDH at our institution between August 1999 and August 2008 was analyzed in detail. All patients were divided into three groups according to age to identify any age-dependent clinical characteristics. Group A comprised 7 infants aged 0 to 3 years, group B 28 children aged 4 to 9 years, and group C 13 children aged 10 to 15 years. We reviewed retrospectively medical records and analyzed clinical status and radiological findings including age, causes of injury, initial Glasgow coma scale (GCS) or Modified GCS, location of hematoma, conservative or surgical treatment, and Glasgow outcome scale (GOS).

Results

Thirty-two patients were male and 16 patients were female. The most frequent cause of trauma was pedestrian car accident, followed by fall, and slip. Initial GCS was mild (13-15) in 39 children, moderate (9-12) in 5, and severe head trauma (3-8) in 4. The location of the hematoma was frontal in 11 children, parieto-occipital in 23, temporal in 8, and posterior cranial fossa in 6. There was statistically significant correlation between initial GCS and GOS (p<0.05).

Conclusion

Pediatric AEDH presents both age related and atypical features when compared with AEDH in adults. In selected cases, prompt surgical evacuation of the hematoma results in an excellent outcome. Operative treatment of AEDH has few difficulties for a surgeon with neurosurgical training. The outcome was found to be predominantly affected by the initial neurological status.

Keywords: Children, Acute epidural hematoma, Head trauma

Figures and Tables

FIGURE 1

The number of acute epidural hematoma (AEDH) according to age distribution of patients.

FIGURE 2

The location of acute epidural hematoma in children.

TABLE 1

Modified Glasgow coma scale for infants and children

TABLE 2

Causes of injury in infants and children with acute epidural hematoma

TABLE 3

Final outcome in relation to initial consciousness level

^*p<0.05 between good (GOS 5 & 4) and poor (GOS 3, 2 & 1) outcome. GCS: Glasgow coma scale, GOS: Glasgow outcome scale

References

1. Ammirati M, Tomita T. Epidural hematomas in infancy and childhood. Rev Neurosci Pediatr. 1985; 1:123–128.

2. Campbell JB, Cohen J. Epidural hemorrhage and the skull of children. Surg Gynecol Obstet. 1951; 92:257–280.

3. Choi WJ, Song SH, Koh HS, Youm JY, Kim SH, Kim Y. Clinical characteristics of traumatic epidural hematoma: a comparison between children and adults. J Korean Neurosurg Soc. 1997; 26:422–429.

4. Choux M, Grisoli F, Peragut JC. Extradural hematomas in children. 104 cases. Childs Brain. 1975; 1:337–347.

5. Dhellemmes P, Lejeune JP, Christiaens JL, Combelles G. Traumatic extradural hematomas in infancy and childhood. Experience with 144 cases. J Neurosurg. 1985; 62:861–864.

6. Galbraith S, Smith J. Acute traumatic intracranial haematoma without skull fracture. Lancet. 1976; 1:501–503.

7. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975; 1:480–484.

8. Molloy CJ, McCaul KA, McLean AJ, North JB, Simpson DA. Extradural haemorrhage in infancy and childhood. A review of 35 years' experience in South Australia. Childs Nerv Syst. 1990; 6:383–387.

9. Neubauer UJ. Extradural haematoma of the posterior fossa. Twelve years experiences with CT-scan. Acta Neurochir (Wien). 1987; 87:105–111.

10. Paşaoğlu A, Orhon C, Koç K, Selçuklu A, Akdemir H, Uzunoğlu H. Traumatic extradural haematomas in pediatric age group. Acta Neurochir (Wien). 1990; 106:136–139.

11. Pillay R, Peter JG. Extradural haematomas in children. S Afr Med J. 1995; 85:672–674.

12. Rocchi G, Caroli E, Raco A, Salvati M, Delfini R. Traumatic epidural hematoma in children. J Child Neurol. 2005; 20:569–572.

13. Roda JM, Giménez D, Pérez-Higueras A, Blázquez MG, Pérez-Alvarez M. Posterior fossa epidural hematomas: a review and synthesis. Surg Neurol. 1983; 19:419–424.

TOOLS

Similar articles