Clinico-radiological correlation with outcome in traumatic pediatric extradural hematoma: A single institutional experience

Abstract

A BSTRACT Background: Head injury is one of the leading causes of mortality and morbidity in the developing as well as developed countries. Extradural hematoma is seen in 1–2% of cases of head injury patients. Extradural hematoma is infrequent in the pediatric age group (less than 18 years) as duramater is tightly adherent to the inner table of the skull and is present in about 1–3% of all pediatric head injuries. Materials and Methods: The study was a prospective study conducted in the Department of Neurosurgery at PGIMER, Dr. RML Hospital, New Delhi, over a period of 19 months with a follow-up of 6 months. In total, 38 patients were enrolled in the study. All traumatic extradural hematoma below 18 years of age of both sexes were included. Follow-up of all patients was done at 2 weeks, 1, 2, and 6 months. Noncontrast computed tomography (NCCT) head was done in all patients at the time of admission and whenever their neurological status deteriorated. Routine postoperative NCCT head was done. Outcome assessment was done by Glasgow outcome scale. Results: Of the 38 children, 21 were males and 17 were females. The maximum number of patients was between the ages of 1–5 years (55.26%). Fall from height was the most common cause. Loss of consciousness was the most common presenting symptom (78.94%). Thirty-three patients had GCS of 14–15 at the time of presentation. The parietal region was the most common location of EDH in our study (44.74%). Thirty-five patients had supratentorial and three patients had infratentorial EDH. Eighteen patients had associated brain injury, commonest being brain edema. Six patients were operated. There was no mortality in our study. Two patients had limb paresis. Conclusion: Pediatric EDH is a rare entity but a potentially life-threatening condition. Prompt diagnosis and timely intervention decrease morbidity and mortality.

Clinico-radiological correlation with outcome in acute epidural haematoma: a tertiary centre experience from Nepal

“…There was a higher incidence of EDH in males than females, which is consistent with other studies 13 – 15 . The male preponderance may be attributed to the early riding of unsupervised two-wheelers and more physical and outdoor sports activities than girls 16 .…”

“…Similar to our study, the study by Jamieson and colleagues and Sobti and colleagues also showed loss of consciousness as a most common presentation 15 , 24 . 44.9% of patients presented with loss of consciousness, and there was a statistically significant difference when correlated with the number of days in the hospital.…”

“…Falls were the most common mechanism of injury (64.5%), followed by road traffic accidents (RTA) (19.6%) and physical assaults (9.3%). This was similarly observed in a study conducted in Nepal and India 15 , 17 – 21 . In contrast, Umerani et al .…”

“…Aromatario and colleagues and Sobti and colleagues have reported that lower GCS at presentation correlates with an unfavourable outcome 15 , 26 . In contrast, in our case, only six patients had severe GCS scores and spent more days in the hospital than those with mild scores.…”

Impact of Delayed Presentation on the Surgical Outcome of Epidural Hematoma in Traumatic Brain Injury Patients

“…The literature reports GCS at the time of presentation, age, associated intradural lesions as well as time between evacuation of hematoma because of transfer of the affected individual to neurosurgery unit as some of the most significant factors influencing outcomes among such patients. [9][10][11][12] Rehman L et al following patients of acute traumatic extradural hematoma for duration of 3 months revealed that 24 (80.0%) cases had had good outcome, one (3.33%) had moderate disability (left sided weakness), one (3.33%) remained in vegetative state, while mortality was noted in 3 (10.0%) cases. Rehman L et al also observed that patients who had GCS scores between 13-15 had significantly better otucomes (p=0.01) while mortality was significantly among patients who had GCS scores between 3-8 (p=0.01).…”