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South African Journal of Surgery

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Acute extradural haematomas in children: A 12-year experience from a single neurosurgery unit

B Enicker, H Louw, T Madiba

Abstract


Background: Acute extradural haematomas (AEDHs) occur infrequently in children. This study was undertaken to review our experience with management and outcomes of this condition in children treated in the Neurosurgery Unit at Inkosi Albert Luthuli Central Hospital.

Methods: A retrospective review of medical records of all children (age less than or equal to (≤) 12 years) with a diagnosis of AEDH admitted from January 2003 to December 2014 was performed. Records were analyzed for demographics, mechanisms of injury, clinical presentation, neuroradiology findings, management and outcomes at discharge.

Results: A total of 150 children with AEDHs were admitted during this period. The mean age was 6.6 ± 3.8 years with a peak incidence in the 7-9 year age group. There were 84 (56%) males, (M: F= 1.3:1). Sixty AEDHs resulted from road traffic crashes (40%). On admission 104 (69.3%) children were Glasgow coma scale (GCS) 13-15, 26 (17.3%) GCS 9-12 and 20 (13.4%) GCS 3-8. Haemoglobin was less than (<) 8 g/dl in 56% of infants (p < 0.001). Skull fractures were identified in 78% of cases. Surgical management was undertaken in 83% of children and the mean hospital stay was 6.9 ± 6.1 days. Four children (2.7%) died during in-hospital stay period. One hundred and forty one (94%) children had a favourable Glasgow outcome scale (GOS) at discharge.

Conclusion: AEDHs in children carry a good prognosis, but can be potentially fatal. A vigilant approach is required when assessing these children, as early diagnosis and treatment yields gratifying results.

Keywords: Acute extradural haematoma, children, craniotomy




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