title: Epidural hematomas in children.
abstract: OBJECTIVE
  To describe the presentation, management, and outcome of children with traumatic epidural hematoma.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Fifty-three children diagnosed with traumatic epidural hematoma on computed tomography scan who were treated at Children's Hospital in Boston between 1980 and 1990.
  
  
  RESULTS
  Twenty-four of 53 children developed an epidural hematoma after a fall of less than 5 ft. At the time of diagnosis, 51 of 53 children had one or more symptoms of vomiting, headache, or lethargy. Twenty-six patients were alert, 21 were responsive to verbal or painful stimuli, and five were unresponsive or posturing. Twenty-one (40%) had acute neurologic deterioration before surgery; however, 20 (38%) were alert with normal vital signs and neurologic examinations at diagnosis. All patients survived, and at the time of discharge 45 had normal examinations and eight had neurologic abnormalities; at follow-up only four of these eight had persistent (although mild) abnormalities.
  
  
  CONCLUSIONS
  Although often dramatic in presentation, epidural hematoma may occur after relatively minor head trauma and in alert children with nonfocal neurologic examinations. In our study, incidence of neurologic sequelae increased if abnormal neurologic examination or depressed mental status was present at diagnosis. The outcome of children in this study is improved from that of previous studies, perhaps due to increased use of computed tomography and higher incidence of low- or moderate-impact trauma in this series.
authors.affiliation: Division of Emergency Medicine, Children's Hospital, Boston, Massachusetts.
authors.forename: S A
authors.initials: SA
authors.lastname: Schutzman
authors.forename: P D
authors.initials: PD
authors.lastname: Barnes
authors.forename: M
authors.initials: M
authors.lastname: Mantello
authors.forename: R M
authors.initials: RM
authors.lastname: Scott
mesh_terms: D000293:Adolescent; D001925:Brain Damage, Chronic / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003243:Consciousness; D006259:Craniocerebral Trauma / Q000150:complications; D003627:Data Interpretation, Statistical; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000150:complications / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D009460:Neurologic Examination; D010808:Physical Examination; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed