Pediatr Emerg Care. 2023 Jun 1;39(6):402-407. doi: 10.1097/PEC.0000000000002825. Epub 2022 Oct 21.
Optimal treatment of children with traumatic intracranial epidural hematomas (EDHs) is unknown. We sought to identify clinical and radiographic predictors of delayed surgical intervention among children with EDH admitted for observation.
We retrospectively identified patients younger than 15 years with acute traumatic EDHs evaluated at our level 1 pediatric trauma center. We excluded patients with penetrating head injuries, recent surgical evacuation of EDH, or depressed skull fracture requiring surgical repair and assigned the remaining subjects to the immediate surgery group if they underwent immediate surgical evacuation, to the supportive-therapy-only group if they underwent observation only, and to the delayed surgery group if they underwent surgery after observation. We abstracted clinical and laboratory findings, surgical interventions, and neurological outcome and measured EDH dimensions and volumes, adjusting for cranial size. We compared clinical and radiographic characteristics among groups and performed receiver-operator characteristic analyses of predictors of delayed surgery.
Of 172 patients with EDH, 103 patients met the inclusion criteria, with 6 (6%) in the immediate surgery group, 87 (84%) in the supportive-therapy-only group, and 10 (10%) in the delayed surgery group. Headache, prothrombin time of >14 seconds, EDH maximal thickness of ≥1.1 cm, volume of ≥14 mL, EDH thickness/cranial width index of ≥0.08 and EDH volume/cranial volume index of ≥0.18, and mass effect were associated with delayed surgical intervention. There was no difference in length of stay or functional impairment between the immediate and delayed surgery groups. However, patients in delayed surgery group were more likely to have subjective symptoms at discharge than those in immediate surgery group.
Among patients with EDH admitted for observation, larger EDH, mass effect, headaches, and prothrombin time of >14 seconds were associated with delayed surgical intervention. A larger-scale study is warranted to identify independent predictors of delayed surgery in children under observation for EDH.
儿童创伤性硬脑膜外血肿（EDH）的最佳治疗方法尚不清楚。我们旨在确定接受观察治疗的 EDH 患儿延迟手术干预的临床和影像学预测因素。
我们回顾性地确定了在我们的 1 级儿科创伤中心接受评估的年龄小于 15 岁的急性创伤性 EDH 患者。我们排除了穿透性头部损伤、最近行 EDH 手术清除、或需要手术修复的凹陷性颅骨骨折的患者，并将其余患者分为立即手术组（如果他们接受了立即手术清除）、单纯支持治疗组（如果他们仅接受观察）和延迟手术组（如果他们在观察后接受手术）。我们提取了临床和实验室发现、手术干预和神经结局，并根据颅骨大小测量 EDH 尺寸和体积。我们比较了各组之间的临床和影像学特征，并对延迟手术的预测因素进行了接受者操作特征分析。
在 172 例 EDH 患者中，有 103 例符合纳入标准，其中 6 例（6%）在立即手术组，87 例（84%）在单纯支持治疗组，10 例（10%）在延迟手术组。头痛、凝血酶原时间>14 秒、EDH 最大厚度≥1.1cm、体积≥14ml、EDH 厚度/颅骨宽度指数≥0.08 和 EDH 体积/颅骨体积指数≥0.18、以及占位效应与延迟手术干预相关。立即手术组和延迟手术组的住院时间或功能障碍无差异。然而，延迟手术组的患者在出院时比立即手术组的患者更有可能出现主观症状。
在接受观察治疗的 EDH 患者中，较大的 EDH、占位效应、头痛和凝血酶原时间>14 秒与延迟手术干预相关。需要更大规模的研究来确定接受 EDH 观察治疗的儿童中延迟手术的独立预测因素。
