gms | German Medical Science

Objective: This retrospective study of infants with epidural hematoma was undertaken to evaluate the initial clinical and radiological status regarding the therapeutic decision-making. Additionally factors affecting the initial neurological status and outcome were investigated.

Methods: Between 2007 and 2018 8 infants under the age of one year with epidural haematoma were identified. We investigated the neurological, important haematological and radiological findings, treatment methods of the epidural hematoma and the neurological outcome. Neurological status was assessed using the Glasgow Coma Scale (GCS). The mean follow-up time was three months.

Results: There were 6 male and 2 female patients. Median Glasgow Coma Scale (GCS) at presentation was 12.5 (range from 3 to 15). Traumatic brain injury due to falls was the most common cause of epidural hematoma (n= 6). The initial mean thickness of hematoma was 29.9 (±14) mm, the mean midline shift was 9.7 (±5.6) mm. Those infants (n=6) who underwent surgical treatment had a mean hematoma thickness of 31.8 (±12.7) mm and mean midline shift of 9.7 (±5.6) mm compared to 24 (±16) mm and 0 mm in the non-surgical group, respectively. The surgical treatment was performed at hematoma thickness of more then 8 mm. The documented median GCS of surgical treated infants was 11 (3–15) compared to 12.5 (10–15) in conservatively treated infants. All patients were discharged with a GCS of 15. The timing of surgery, blood coagulation state and blood loss were not significantly associated with the clinical outcome.

Conclusion: The thickness of hematoma, midline shift and blood coagulation state proofed to be important for therapeutic decision-making. Treatment of epidural hematoma in infants under the age of one year is an individual decision but the main reason for surgery in our group was the worsening of neurological findings.