Conservative Treatment of Mildly Symptomatic Large Extradural Hematomas in The Pediatric Age Group: A Report of 20 Cases

Year 2023, , 98 - 104, 30.09.2023

Rıfat Akdağ , Uğur Soylu

https://doi.org/10.54996/anatolianjem.1112749

Abstract

Aim: Conservative treatment is a safe alternative to surgical treatment in patients with asymptomatic or mildly symptomatic extradural hematoma seen in the pediatric age group. There is still a debate about patient selection criterias. This study highlights the radiological and clinical features of pediatric large EDH patients treated without surgery.

Material and Methods: In this retrospective-cohort study, we present a review of the data of 20 pediatric EDH patients treated in Health Sciences University, Bursa Yüksek Ihtisas Training and Research Hospital between 2015 and 2020. This study; includes patients with Glasgow Coma Scale (GCS) 14+ and diagnosed EDH thickness ≥ 15mm in computed tomography (CT), treatment protocol and outcomes.

Results: Of the 206 patients diagnosed with EDH, 131 (63,5 %) had an initial GCS ≥ 14. Furthermore, 23 (11,1 %) patients had EDH thickness ≥ 15 mm. 3 patients were excluded from study because of emergent surgery. The number of patients included in the study was 20 and all patients had a GOS score of 5 on at least one -year follow-up.

Conclusion: According to our results, conservative treatment is an optimal alternative to surgical treatment in pediatric large EDH patients. However, patient selection and clinical features are very important.

Keywords

Epidural hematoma, conservative management, head trauma, pediatric patients, traumatic brain injury

Pediatrik Yaş Grubunda Hafif Semptomatik Büyük Ekstradural Hematomların Konservatif Tedavisi: 20 Vaka Serisi

Abstract

Amaç: Pediatrik yaş grubunda görülen asemptomatik veya hafif semptomatik ekstradural hematomu olan hastalarda konservatif tedavi cerrahi tedaviye güvenli bir alternatiftir. Hasta seçim kriterleri hakkında hala bir tartışma vardır. Bu çalışma, ameliyatsız tedavi edilen pediatrik büyük EDH hastalarının radyolojik ve klinik özelliklerini vurgulamaktadır.

Gereç ve Yöntemler: Bu retrospektif-kohort çalışmada, Sağlık Bilimleri Üniversitesi Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi'nde 2015-2020 yılları arasında tedavi gören 20 pediatrik EDH hastasının verilerinin bir derlemesini sunuyoruz. Bu çalışma; Glasgow Koma Skalası (GCS) 14+ olan ve bilgisayarlı tomografide (BT) EDH kalınlığı ≥ 15 mm olan hastaları, tedavi protokolünü ve sonuçlarını içermektedir.

Bulgular: EDH tanısı konan 206 hastanın 131'inde (%63,5) başlangıç GCS ≥ 14 idi. Ayrıca 23'ünde (%11,1) EDH kalınlığı ≥ 15 mm idi. Acil cerrahi nedeniyle 3 hasta çalışma dışı bırakıldı. Çalışmaya dahil edilen hasta sayısı 20 idi ve tüm hastaların en az bir yıllık takipte GOS skoru 5 idi.

Sonuç: Sonuçlarımıza göre, pediatrik büyük EDH hastalarında konservatif tedavi cerrahi tedaviye optimal bir alternatiftir. Ancak hasta seçimi ve klinik özellikler çok önemlidir.

Keywords

Epidural hematom, konservatif tedavi, kafa travması, çocuk hasta, travmatik beyin hasarı

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