Management of epidural hematomas in pediatric patients presenting with a GCS of 14 or better

Michael T. Bounajem, D. Clay Samples, David J. Wallace, Samon Tavakoli, Lillian Liao, Izabela Tarasiewicz

Research output: Contribution to journalArticle

Abstract

Object: Guidelines for the management of pediatric epidural hematoma (PEDH) remain poorly defined. Here we seek to characterize the disease course of PEDH in patients with presenting Glasgow Coma Scale (GCS) of 14+, and suggest high-risk characteristics for progression to surgery. Methods: A prospectively maintained, single-institution, level-1 trauma hospital admission database was queried to identify patients ages 6 months to 18 years presenting with PEDH between 2006 and 2016. Selected charts were reviewed for clinical information and treatment. Head imaging was reviewed for hematoma size, location, fractures, and midline shift. Results: Of 210 cases reviewed, 117 presented with a GCS of 14+. Of these, 24 required surgery while 93 were managed conservatively. Factors leading to surgery included decline in GCS (40%), size alone (21%), localizing neurological deficit (20%), progression on repeat imaging (12%), and other (7%). Hematomas involving the temporal lobe plus an adjacent lobe were more likely to proceed to surgery than those involving the temporal lobe alone (OR: 24.8, 95% CI (4.74, 129.26)). Hematomas in proximity to the superior sagittal and transverse sinuses proceeded to surgery in 33.3% and 37.5% of cases, respectively. Of the 93 patients with a thickness:biparietal skull diameter ratio of ≤0.15, 89 (95.7%) were managed conservatively. Conclusion: In this single-institution experience, 21% of pediatric patients presenting with a GCS of 14+ proceeded to surgery. High-risk features include large hematoma thickness, proximity to the transverse sinus, and multilobar location. A thickness:biparietal skull diameter ratio less than 0.15 was highly unlikely to proceed to surgery.

Original languageEnglish (US)
JournalJournal of Clinical Neuroscience
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Glasgow Coma Scale
Hematoma
Pediatrics
Transverse Sinuses
Temporal Lobe
Skull
Superior Sagittal Sinus
Head
Databases
Guidelines
Wounds and Injuries

Keywords

  • Epidural hematoma
  • Management
  • Pediatric
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology
  • Physiology (medical)

Cite this

Management of epidural hematomas in pediatric patients presenting with a GCS of 14 or better. / Bounajem, Michael T.; Samples, D. Clay; Wallace, David J.; Tavakoli, Samon; Liao, Lillian; Tarasiewicz, Izabela.

In: Journal of Clinical Neuroscience, 01.01.2019.

Research output: Contribution to journalArticle

Bounajem, Michael T. ; Samples, D. Clay ; Wallace, David J. ; Tavakoli, Samon ; Liao, Lillian ; Tarasiewicz, Izabela. / Management of epidural hematomas in pediatric patients presenting with a GCS of 14 or better. In: Journal of Clinical Neuroscience. 2019.
@article{ca9ec1e247634ddda89bc2edea353a70,
title = "Management of epidural hematomas in pediatric patients presenting with a GCS of 14 or better",
abstract = "Object: Guidelines for the management of pediatric epidural hematoma (PEDH) remain poorly defined. Here we seek to characterize the disease course of PEDH in patients with presenting Glasgow Coma Scale (GCS) of 14+, and suggest high-risk characteristics for progression to surgery. Methods: A prospectively maintained, single-institution, level-1 trauma hospital admission database was queried to identify patients ages 6 months to 18 years presenting with PEDH between 2006 and 2016. Selected charts were reviewed for clinical information and treatment. Head imaging was reviewed for hematoma size, location, fractures, and midline shift. Results: Of 210 cases reviewed, 117 presented with a GCS of 14+. Of these, 24 required surgery while 93 were managed conservatively. Factors leading to surgery included decline in GCS (40{\%}), size alone (21{\%}), localizing neurological deficit (20{\%}), progression on repeat imaging (12{\%}), and other (7{\%}). Hematomas involving the temporal lobe plus an adjacent lobe were more likely to proceed to surgery than those involving the temporal lobe alone (OR: 24.8, 95{\%} CI (4.74, 129.26)). Hematomas in proximity to the superior sagittal and transverse sinuses proceeded to surgery in 33.3{\%} and 37.5{\%} of cases, respectively. Of the 93 patients with a thickness:biparietal skull diameter ratio of ≤0.15, 89 (95.7{\%}) were managed conservatively. Conclusion: In this single-institution experience, 21{\%} of pediatric patients presenting with a GCS of 14+ proceeded to surgery. High-risk features include large hematoma thickness, proximity to the transverse sinus, and multilobar location. A thickness:biparietal skull diameter ratio less than 0.15 was highly unlikely to proceed to surgery.",
keywords = "Epidural hematoma, Management, Pediatric, Trauma",
author = "Bounajem, {Michael T.} and Samples, {D. Clay} and Wallace, {David J.} and Samon Tavakoli and Lillian Liao and Izabela Tarasiewicz",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jocn.2019.08.056",
language = "English (US)",
journal = "Journal of Clinical Neuroscience",
issn = "0967-5868",
publisher = "Churchill Livingstone",

}

TY - JOUR

T1 - Management of epidural hematomas in pediatric patients presenting with a GCS of 14 or better

AU - Bounajem, Michael T.

AU - Samples, D. Clay

AU - Wallace, David J.

AU - Tavakoli, Samon

AU - Liao, Lillian

AU - Tarasiewicz, Izabela

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Object: Guidelines for the management of pediatric epidural hematoma (PEDH) remain poorly defined. Here we seek to characterize the disease course of PEDH in patients with presenting Glasgow Coma Scale (GCS) of 14+, and suggest high-risk characteristics for progression to surgery. Methods: A prospectively maintained, single-institution, level-1 trauma hospital admission database was queried to identify patients ages 6 months to 18 years presenting with PEDH between 2006 and 2016. Selected charts were reviewed for clinical information and treatment. Head imaging was reviewed for hematoma size, location, fractures, and midline shift. Results: Of 210 cases reviewed, 117 presented with a GCS of 14+. Of these, 24 required surgery while 93 were managed conservatively. Factors leading to surgery included decline in GCS (40%), size alone (21%), localizing neurological deficit (20%), progression on repeat imaging (12%), and other (7%). Hematomas involving the temporal lobe plus an adjacent lobe were more likely to proceed to surgery than those involving the temporal lobe alone (OR: 24.8, 95% CI (4.74, 129.26)). Hematomas in proximity to the superior sagittal and transverse sinuses proceeded to surgery in 33.3% and 37.5% of cases, respectively. Of the 93 patients with a thickness:biparietal skull diameter ratio of ≤0.15, 89 (95.7%) were managed conservatively. Conclusion: In this single-institution experience, 21% of pediatric patients presenting with a GCS of 14+ proceeded to surgery. High-risk features include large hematoma thickness, proximity to the transverse sinus, and multilobar location. A thickness:biparietal skull diameter ratio less than 0.15 was highly unlikely to proceed to surgery.

AB - Object: Guidelines for the management of pediatric epidural hematoma (PEDH) remain poorly defined. Here we seek to characterize the disease course of PEDH in patients with presenting Glasgow Coma Scale (GCS) of 14+, and suggest high-risk characteristics for progression to surgery. Methods: A prospectively maintained, single-institution, level-1 trauma hospital admission database was queried to identify patients ages 6 months to 18 years presenting with PEDH between 2006 and 2016. Selected charts were reviewed for clinical information and treatment. Head imaging was reviewed for hematoma size, location, fractures, and midline shift. Results: Of 210 cases reviewed, 117 presented with a GCS of 14+. Of these, 24 required surgery while 93 were managed conservatively. Factors leading to surgery included decline in GCS (40%), size alone (21%), localizing neurological deficit (20%), progression on repeat imaging (12%), and other (7%). Hematomas involving the temporal lobe plus an adjacent lobe were more likely to proceed to surgery than those involving the temporal lobe alone (OR: 24.8, 95% CI (4.74, 129.26)). Hematomas in proximity to the superior sagittal and transverse sinuses proceeded to surgery in 33.3% and 37.5% of cases, respectively. Of the 93 patients with a thickness:biparietal skull diameter ratio of ≤0.15, 89 (95.7%) were managed conservatively. Conclusion: In this single-institution experience, 21% of pediatric patients presenting with a GCS of 14+ proceeded to surgery. High-risk features include large hematoma thickness, proximity to the transverse sinus, and multilobar location. A thickness:biparietal skull diameter ratio less than 0.15 was highly unlikely to proceed to surgery.

KW - Epidural hematoma

KW - Management

KW - Pediatric

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=85070546900&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070546900&partnerID=8YFLogxK

U2 - 10.1016/j.jocn.2019.08.056

DO - 10.1016/j.jocn.2019.08.056

M3 - Article

AN - SCOPUS:85070546900

JO - Journal of Clinical Neuroscience

JF - Journal of Clinical Neuroscience

SN - 0967-5868

ER -