Conservative Management of Supratentorial Extradural Hematomas in Children
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- Category: Vol. 82, June 2014
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Conservative Management of Supratentorial Extradural Hematomas in Children, MOHAMED A. EL-GAIDI
Abstract
Background: Acute Extradural Hematoma (EDH) is less common in children compared to adults, which can be ex-plained by the relative flexibility of skull bones at this age which make fractures less frequent than in adults. Furthermore, EDH at this age is characterized by non-specific clinical presentation and inability of very young children to commu-nicate. However, the management guidelines of EDH in children are ill-defined.
Objective: The aim of this study is to assess the safety and efficiency of Bullock et al guidelines for conservative management of EDH in Children.
Patients and Methods: This was a prospective study conducted in Al-Manial university hospital, Kasr Al-Aini Medical School, Cairo University, over a period of one year duration. The study included children (<15 years old) with Glasgow Coma Scale (9-15) suffering from supratentorial EDH (thickness <15mm, volume <30cc and midline shift <5mm) without any focal neurological deficits according to Bullock et al., guidelines.
Results: 18 children (13 boys and 5 girls) matched these criteria and underwent conservative treatment. The most common mode of trauma was fall from height (usually 1.5 meters) (72%), while the most common sites of hematoma were frontal and parietal (33.3% and 27.8% respectively). Early follow-up computed tomography (CT) scan revealed enlargement of seven cases (38.8%), six of them continued the conservative management. While one case exceeded the required parameters for continued conservative treatment and was evacuated successfully. Thus the success rate of conser-vative management of EDH was (94.4%). There was no mortality and all patients had good outcome.
Conclusion: Conservative management of EDH in children is safe and effective if the guidelines of Bullock et al., were followed. However, if conservative treatment of EDH is considered, it is mandatory to secure adequate neurological monitoring and the possibility of urgent evacuation at any time especially in borderline cases.