Pediatric patients with traumatic epidural hematoma at low risk for deterioration and need for surgical treatment.
BACKGROUND
Although some pediatric patients with small traumatic epidural hematoma (EDH) are observed without surgical drainage, clinical practice remains variable.


OBJECTIVE
Create a prediction rule to identify patients with EDH unlikely to fail hospital observation.


METHODS
Retrospective review at a level I pediatric trauma center between 2003 and 2014. Presenting clinical and radiographic features were compared between those successfully to failed observation.


RESULTS
Two hundred twenty-two patients with EDH whose initial management strategy was observation were analyzed; 196 (88%) were successfully observed. The group failing observation was more likely to present with altered mental status (RR 18.8; 95% CI 8.7-49.6), has larger median bleed thickness (observed = 5.6mm versus failed observation = 10.9mm, p<0.01), median bleed volume (observed = 2.1ml versus failed observation = 15.7ml, p<0.01), and mass effect (RR 3.7; 95% CI 1.8-7.7). No mass effect, EDH volume<15ml, and no neurologic deficits predicted patients at low risk of failing observation with a positive predictive value of 98% (95% CI 93-99%). There was no difference in median discharge Glasgow outcome scores (5 in both groups, p=0.20).


CONCLUSIONS
Patients with no mass effect and EDH volume <15ml on initial CT scan and no neurologic deficit are at low risk of failing observation.


METHODS
Retrospective cohort level I.
University of Utah, Department of Pediatrics, Division of Critical Care, Salt Lake City, UT 84108. Electronic address: brian.flaherty@hsc.utah.edu.
Brian F
BF
Flaherty
University of Southern California, Keck School of Medicine, Los Angeles, CA 90033.
Hannah E
HE
Moore
University of Calgary, Department of Clinical Neurosciences, Section of Neurosurgery, Alberta Children's Hospital, Calgary, AB T3B 6A8.
Jay
J
Riva-Cambrin
University of Utah, Department of Pediatrics, Division of Critical Care, Salt Lake City, UT 84108.
Susan L
SL
Bratton
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making / Q000379:methods*; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006407:Hematoma, Epidural, Cranial / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D057832:Watchful Waiting
Epidural hematoma; Head injury; Observation; Pediatric; Trauma