Lindsay Call1, Qian Qiu2, Jeffrey Morris3, Brian Flaherty4, Monica S Vavilala5, Brianna Mills2, Susan Bratton4, Mahmud Mossa-Basha3. 1. Amherst College, 220 South Pleasant Street, Amherst, MA 01002. 2. Harborview Injury Prevention Research Center, 401 Broadway St, Seattle, WA 98104, United States. 3. Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, United States. 4. Department of Pediatrics, University of Utah, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113, United States. 5. Department of Anesthesia, Harborview Medical Center, 325 9th Ave, Seattle, WA 98104, United States.
Abstract
OBJECTIVE: The study aimed to validate admission clinical and radiographic features of pediatric patients with traumatic epidural hematoma (EDH) that lead to safe observation. METHODS: A Level I trauma center radiology and electronic medical record databases were retrospectively queried for pediatric patients with EDH on CT scan between 1/1/2016 and 10/1/2016. Patient imaging, treatment and outcome variables were abstracted. Characteristics of the cohort were compared to an external cohort used to develop prediction rules for surgical intervention. External validity of the prediction rules was assessed. RESULTS: 195 eligible subjects were included in the study, 37 of which failed observation and required surgery while 158 underwent successful observation. The surgical cohort had significantly thicker (p < .001) and higher volume (p < .001) EDH, increased midline shift (p < .001) and higher likelihood of mass effect (p < .001). There was significantly higher residual neurologic deficit rate (54% vs 23%, p < .001) and hospital mortality (5% vs 0%, p = .035) amongst the surgical group. There were significant differences in patient demographic, clinical and imaging characteristics between the internal and external cohorts. The predictive rules externally developed yielded positive predictive value of 97.7% (95% CI = 93.3-99.5%), negative predictive value of 24.5% (95% CI = 16.2-34.4%), specificity of 88.5% (95% CI = 69.9-97.6%), and sensitivity of 63.8% (95% CI = 56.6-70.5%) for successful observation. CONCLUSION: The current study validates previously developed prediction rules for safe observation of pediatric EDH in a cohort with distinct characteristics from the external cohort. Specifically, patients with no mass effect, EDH volume <15 ml and no neurological deficits are less likely to fail observation. ADVANCES IN KNOWLEDGE: The current study validates prediction rules for safe observation of pediatric EDH in a distinct pediatric cohort that provides further support to conservative management in these circumstances.
OBJECTIVE: The study aimed to validate admission clinical and radiographic features of pediatric patients with traumatic epidural hematoma (EDH) that lead to safe observation. METHODS: A Level I trauma center radiology and electronic medical record databases were retrospectively queried for pediatric patients with EDH on CT scan between 1/1/2016 and 10/1/2016. Patient imaging, treatment and outcome variables were abstracted. Characteristics of the cohort were compared to an external cohort used to develop prediction rules for surgical intervention. External validity of the prediction rules was assessed. RESULTS: 195 eligible subjects were included in the study, 37 of which failed observation and required surgery while 158 underwent successful observation. The surgical cohort had significantly thicker (p < .001) and higher volume (p < .001) EDH, increased midline shift (p < .001) and higher likelihood of mass effect (p < .001). There was significantly higher residual neurologic deficit rate (54% vs 23%, p < .001) and hospital mortality (5% vs 0%, p = .035) amongst the surgical group. There were significant differences in patient demographic, clinical and imaging characteristics between the internal and external cohorts. The predictive rules externally developed yielded positive predictive value of 97.7% (95% CI = 93.3-99.5%), negative predictive value of 24.5% (95% CI = 16.2-34.4%), specificity of 88.5% (95% CI = 69.9-97.6%), and sensitivity of 63.8% (95% CI = 56.6-70.5%) for successful observation. CONCLUSION: The current study validates previously developed prediction rules for safe observation of pediatric EDH in a cohort with distinct characteristics from the external cohort. Specifically, patients with no mass effect, EDH volume <15 ml and no neurological deficits are less likely to fail observation. ADVANCES IN KNOWLEDGE: The current study validates prediction rules for safe observation of pediatric EDH in a distinct pediatric cohort that provides further support to conservative management in these circumstances.
Authors: Martin H Osmond; Terry P Klassen; George A Wells; Rhonda Correll; Anna Jarvis; Gary Joubert; Benoit Bailey; Laurel Chauvin-Kimoff; Martin Pusic; Don McConnell; Cheri Nijssen-Jordan; Norm Silver; Brett Taylor; Ian G Stiell Journal: CMAJ Date: 2010-02-08 Impact factor: 8.262
Authors: H Binder; M Majdan; T M Tiefenboeck; A Fochtmann; M Michel; S Hajdu; W Mauritz; J Leitgeb Journal: Orthop Traumatol Surg Res Date: 2016-09-09 Impact factor: 2.256
Authors: Nathan Kuppermann; James F Holmes; Peter S Dayan; John D Hoyle; Shireen M Atabaki; Richard Holubkov; Frances M Nadel; David Monroe; Rachel M Stanley; Dominic A Borgialli; Mohamed K Badawy; Jeff E Schunk; Kimberly S Quayle; Prashant Mahajan; Richard Lichenstein; Kathleen A Lillis; Michael G Tunik; Elizabeth S Jacobs; James M Callahan; Marc H Gorelick; Todd F Glass; Lois K Lee; Michael C Bachman; Arthur Cooper; Elizabeth C Powell; Michael J Gerardi; Kraig A Melville; J Paul Muizelaar; David H Wisner; Sally Jo Zuspan; J Michael Dean; Sandra L Wootton-Gorges Journal: Lancet Date: 2009-09-14 Impact factor: 79.321
Authors: Jacob K Greenberg; Margaret A Olsen; Gabrielle W Johnson; Ranbir Ahluwalia; Madelyn Hill; Andrew T Hale; Ahmed Belal; Shawyon Baygani; Randi E Foraker; Christopher R Carpenter; Laurie L Ackerman; Corina Noje; Eric M Jackson; Erin Burns; Christina M Sayama; Nathan R Selden; Shobhan Vachhrajani; Chevis N Shannon; Nathan Kuppermann; David D Limbrick Journal: Neurosurgery Date: 2022-03-16 Impact factor: 5.315