title: Metabolic and clinical markers of prognosis in the era of CT imaging in children with acute epidural hematomas.
abstract: Acute epidural hematoma (AEH), a relatively common complication of head injury in children, persists in bearing high morbidity and mortality. Early establishment of prognosis could guide optimal patient allocation, and early identification of predictive signs could assist in choosing appropriate therapeutic interventions. This study aimed to delineate expeditiously obtainable prognostic markers for determining outcome in a subset of children with AEH. We reviewed our 11-year experience with 61 consecutive children <16 years old with head trauma and isolated AEH. Treatment followed a standard advanced trauma life support protocol. A medical history was obtained, and all patients underwent neurosurgical and physical evaluations. CT scans were performed, as were laboratory tests which included arterial blood gases, glucose, electrolytes (K(+), Na(+)), hemoglobin and coagulation studies. Evaluation of the data collected on cause of injury, interval between trauma occurrence and presentation, clinical symptoms, Glasgow Coma Scale (GCS) scores, vital signs, laboratory test results, physical findings and surgical versus conservative management revealed that the best single predictors of outcome following AEH were the GCS and focal neurological deficits. Of all laboratory data obtained on admission, the blood potassium, pH and glucose test results correlated significantly with prognosis. Prognosis can be adequately and expeditiously estimated by selected markers within a comprehensive evaluation of children with AEH.
authors.affiliation: Department of Pediatric Intensive Care and Pediatric Neurosurgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Ben Abraham
authors.forename: E
authors.initials: E
authors.lastname: Lahat
authors.forename: G
authors.initials: G
authors.lastname: Sheinman
authors.forename: Z
authors.initials: Z
authors.lastname: Feldman
authors.forename: A
authors.initials: A
authors.lastname: Barzilai
authors.forename: R
authors.initials: R
authors.lastname: Harel
authors.forename: Z
authors.initials: Z
authors.lastname: Barzilay
authors.forename: G
authors.initials: G
authors.lastname: Paret
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D015415:Biomarkers; D001930:Brain Injuries / Q000150:complications; D002648:Child; D002675:Child, Preschool; D015600:Glasgow Coma Scale; D006407:Hematoma, Epidural, Cranial / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D015415:Biomarkers