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Extradural hematoma: Experience in achieving zero mortality of children patient in a single center

Abstract

Introduction: Extradural hematoma (EDH), a common sequela of traumatic brain injury, can lead to mortality and disability if there is a delay in identifying the pathology and subsequent management. In the 1920s, the mortality rate was reported as 86% and improved to 10% over the new millennium. We review our EDH cases to identify how we achieved zero mortality, which is the ultimate goal of EDH management.

Methods: We retrospectively reviewed all traumatic EDH cases seen in the specialized pediatric neurosurgery department of Sabah Women & Children Hospital from January 2013 to August 2018. Patients’ case records, operative notes and radiological images were tracked and reviewed. A total of 101 cases were identified.

Results: We had 101 patients ranging from the age of 9 months to 12 years. Fifty-eight patients (58.41%) were males, and 42 were females (41.59%). A total of 37 patients (36.3%) were treated surgically, and 64 patients (63.7%) were treated conservatively. About 92 patients (91.09%) presented with supratentorial EDH and 9 patients (8.91%) had infratentorial EDH. Skull fractures were present in 47 children (46.5%). In the pediatric age group, fall from heights was the most common cause. We achieved zero mortality among our patients who were treated both surgically and conservatively.

Conclusion: EDH is a neurotrauma emergency that can be lethal, yet it is the most rewardingly responsive lesions treated by neurosurgeons. Early diagnosis, prompt referrals, early surgical intervention when indicated, and good intensive care remain the paramount facets towards achieving zero mortality in EDH. This study proves that our results are comparable to those seen in other neurosurgical centers throughout the developed world. An institutional protocol for EDH may ensure that the ultimate goal of towards ‘zero mortality’ could be achieved systematically and consistently.

Keywords: conservative, extradural hematoma, pediatric, surgical, zero mortality

References

  1. Bricolo AP, Pasut LM. Extradural hematoma: Toward zero mortality. A prospective study. Neurosurgery. 1984; 14(1): 8 – 12. DOI: 10.1227/00006123-198401000-00003.
  2. Ciurea AV, Kapsalaki EZ, Coman TC, Roberts JL, Robinson 3rd JS, Tascu A, et al. Supratentorial epidural hematoma of traumatic etiology in infants. Childs Nerv Syst. 2007; 23(3): 335 – 41. DOI: 10.1007/s00381-006-0230-4.
  3. Jamieson KG, Yelland JDN. Extradural Hematoma. J Neurosurg. 1968; 29(1): 13 – 23.
  4. Rocchi G, Caroli E, Raco A, Salvati M, Delfini R. Traumatic epidural hematoma in children. J Child Neurol. 2005; 20(7): 569 – 72. DOI: 10.1177/08830738050200070501.
  5. Cheung PSY, Lam JMY, Yeung JHH, Graham CA, Rainer TH. Outcome of traumatic extradural haematoma in Hong Kong. Injury. 2007; 38(1): 76 – 80. DOI: 10.1016/j.injury.2006.08.059.
  6. Jung S-W, Kim D-W. Our experience with surgically treated epidural hematomas in children. J Korean Neurosurg Soc. 2012; 51(4): 215 – 8. DOI: 10.3340/jkns.2012.51.4.215.
  7. Jamjoom A, Cummins B, Jamjoom ZA. Clinical characteristics of traumatic extradural hematoma: A comparison between children and adults. Neurosurg Rev. 1994; 17(4): 277 – 81. DOI: 10.1007/bf00306818.
  8. Dhellemmes P, Lejeune JP, Christiaens JL, Combelles G. Traumatic extradural hematomas in infancy and childhood. J Neurosurg. 1985; 62(6): 861 – 4. DOI: 10.3171/jns.1985.62.6.0861.
  9. Baykaner K, Alp H, Çeviker N, Keskil S, Seçkin Z. Observation of 95 patients with extradural hematoma and review of the literature. Surg Neurol. 1988; 30(5): 339 – 41. DOI: 10.1016/0090-3019(88)90195-4.
  10. Kvarnes TL, Trumpy JH. Extradural haematoma. Acta Neurochir. 1978; 41(1): 223 – 31.
  11. Robert LM, Lowell EF. Extradural Hematoma. J Neurosurg. 1964; 21(5): 364 – 71.
  12. Ingraham FD, Campbell JB, Cohen J. Extradural hematoma in infancy and childhood. J Am Med Assoc. 1949; 140(12): 1010 – 3.
  13. Erşahin Y, Mutluer S, Güzelbag E. Extradural hematoma: analysis of 146 cases. Childs Nerv Syst. 1993; 9(2): 96 – 9. DOI: 10.1007/bf00305316.

How to Cite

Gannison, L., Rajapathy, S. K., Sriram, P. R., Zenian, S., Arumugam, A., & Sellamuthu, P. (2020). Extradural hematoma: Experience in achieving zero mortality of children patient in a single center. Indonesian Journal of Neurosurgery, 3(1). https://doi.org/10.15562/ijn.v3i1.78

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Lalithambigai Gannison
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Senthil Kumar Rajapathy
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Prabu Rau Sriram
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Sofan Zenian
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Ananda Arumugam
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Pulivendhan Sellamuthu
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