title: Surgical management of traumatic extra dural hematoma in children: Experiences and analysis from 24 consecutively treated patients in a developing country.
abstract: BACKGROUND
  Children with epidural hematoma (EDH) present differently than adults. The outcome of treatment is also different. We aim to report our experiences with EDH in pediatric age group in terms of mode of injury, presenting features, management, and outcomes. We also aim to identify different prognostic indicators in pediatric patients with EDH.
  
  
  METHODS
  We prospectively collected data from 24 consecutively surgically treated pediatric patients. The data collected included presenting features, radiological imaging, details of management, and outcomes. Descriptive analysis was performed and different variables were tested for any statistical significance with Glasgow Outcome Score (GOS).
  
  
  RESULTS
  There were 19 male and 5 female patients. The mean Glasgow Coma Scale (GCS) score at presentation was 9.3 ± 4.4. Falls were the most common cause of EDH. Outcome assessment was done at 3 month follow up. A total of 15 patients had a GOS score of 5, 4 patients had a GOS score of 4, 2 patients had a GOS score of 3, while 3 patients had a GOS score of 1. On univariate analysis, admitting GCS score, patient's age, the time from injury to admission and injury to surgery, anisocoric pupils at presentation and effacement of basal cisterns were significantly associated with the outcome of GOS score.
  
  
  CONCLUSIONS
  Falls are the most common mode of injury leading to EDH in children. Lower GCS at presentation, younger age at trauma, increased time since trauma to surgery and admission, anisocoria and effacement of basal cisterns are statistically significant variables in surgically treated pediatric patients of EDH that confer a poorer prognosis. A timely surgical intervention can result in excellent outcomes.
authors.affiliation: Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Muhammad Babar
authors.initials: MB
authors.lastname: Khan
authors.forename: Muhammad
authors.initials: M
authors.lastname: Riaz
authors.forename: Gohar
authors.initials: G
authors.lastname: Javed
authors.forename: Fauzan Alam
authors.initials: FA
authors.lastname: Hashmi
authors.forename: Maryam
authors.initials: M
authors.lastname: Sanaullah
authors.forename: Syed Ijlal
authors.initials: SI
authors.lastname: Ahmed
keywords: Children; craniotomy; epidural hematoma; glasgow coma scale score; prognostic indicators; surgical management
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