Extradural hematomas in children.

BACKGROUND: Extradural hematomas are rate complications of head injures in children often resulting from minor head traumas. Therefore the management of these ordinary traumas remains controversy since in many asymptomatic cases the intracranial bleeding is detected only by CT scan.
METHODS: During the study period between January 1991 and September 1995 sixty-one patients ranging in age from 5 months to 12 years were operated on for epidural hematomas. They represent about the 3% of all patients admitted for head injury in the same period in our Division. According to the age, children were divided in three groups (G1, G2, G3). Males predominate over females in each group of age. The mechanism of injury, the clinical findings, the neurological assessment on admission, the site of hematoma and the presence of skull fracture were examined in order to identify clinical and diagnostic parameters predicting developing intracranial complications.
RESULTS: The most common cause of head trauma was accidental falls in children under 5 years of age. Otherwise bicycle, pedestrian and car accidents are the main type of injury in older patients. A skull fracture was identified in 49 cases with a homogeneous distribution among the groups of age. Recurrent vomiting was found in about 70% of cases. A loss of consciousness was frequently reported (78%) in older children. Outcome mainly depended on Glasgow or Children Coma Score on admission. In our series the overall mortality rate was 4.9%.
CONCLUSIONS: Our data according with the literature suggest that localized skull traumas, suspected fractures, a loss of consciousness after trauma and recurrent vomiting can be recommended as indications for intracranial complications.