Management of supratentorial epidural hematoma in children: report on 49 patients.
Traumatic head injury is a common cause of mortality and acquired neurological impairment in children. However, pediatric epidural hematomas (EDHs) are not common and few series have studied the evolution of these patients. In this study, we present the results from a sample of patients with EDH with long-term follow-up.


METHODS
Between January 2006 and December 2008, 49 patients with traumatic EDH were treated at our unit. Clinical course, radiological findings and outcomes were evaluated. Neurological status was assessed using the Glasgow Coma Scale (GCS). The patients' ages ranged from one day to 16 years. The mean follow-up was six months.


RESULTS
On admission, most of the patients presented mild trauma and 57% had a GCS of 13-15. The most common symptom was irritability. The most frequent mechanisms of injury were: falling from a height in 29 cases and motor vehicle accidents in 16 cases. Three of these patients presented GCS 3, but only one died. We found a late neurological deficit in nine patients.


CONCLUSIONS
These lesions may occur following mild head trauma and in alert children with nonfocal neurological examinations. However, in children presenting irritability with subgaleal hematomas and a history of loss of consciousness, skull computed tomography must be performed.
Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, SP, Brazil. wellingsonpaiva@yahoo.com.br
Wellingson Silva
WS
Paiva
Almir Ferreira de
AF
Andrade
Luis
L
Mathias Júnior
Vinicius Monteiro de Paula
VM
Guirado
Robson Luis
RL
Amorim
Nadia Nader
NN
Magrini
Manoel Jacobsen
MJ
Teixeira
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006407:Hematoma, Epidural, Cranial / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices