Traumatic Epidural Hematomas in the Pediatric Population: Clinical Characteristics and Diagnostic Pitfalls

J Pediatr Surg. 2020 May 15;S0022-3468(20)30324-9. doi: 10.1016/j.jpedsurg.2020.05.011. Online ahead of print.

Abstract

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.

Keywords: Clinical presentation; Diagnosis; Pediatric patients; Radiographic findings; Traumatic epidural hematoma.