Clinical features |
Head trauma, especially to the temporal or occipital region. |
Possible signs and symptoms include:
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Diagnostic evaluation |
The primary goal is to make the diagnosis of EDH before neurologic deterioration in an asymptomatic or mildly affected child to permit timely surgical intervention, if indicated. |
Determine GCS score*; perform focused neurologic examination looking for signs of increased ICP or herniation that warrant emergency treatment:
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Stabilize the patient, as needed, and then obtain emergency unenhanced head CT. Most children with EDH also meet criteria for Cspine imaging, (plain radiographs or, in patients with coma or signs of cerebral herniation, CT)¶. |
Obtain emergency neurosurgical consultation for all patients with GCS score ≤12 or with EDH on neuroimaging. |
Initial laboratory studies:
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Lumbar puncture is contraindicated. |
Treatment |
All children with an acute EDH require emergency neurosurgical consultation. Children with the following clinical findings require emergency surgical hematoma evacuation:
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During stabilization, manage the patient according to principles of Advanced Trauma Life Support:Δ
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If signs of herniation, provide hyperosmolar therapy (preferably in consultation with a neurosurgeon):◊
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Perform mild hyperventilation (PCO2 30 to 35 mmHg) for children whose signs of herniation do not respond to hyperosmolar therapy. |
ALT: alanine transferase; AST: aspartate transferase; Cspine: cervical spine; CT: computed tomography; EDH: epidural hematoma; GCS: Glasgow Coma Scale; INR: international normalized ratio; IV: intravenous; PCO2: partial pressure of carbon dioxide; PT: prothrombin time; PTT: partial thromboplastin time.
* Utilize the pediatric GCS when indicated. Refer to UpToDate graphics on the GCS.
¶ Refer to UpToDate topics on evaluation and management of cervical spine injuries in children and adolescents.
Δ Refer to UpToDate topics on trauma in the unstable child.
◊ Refer to UpToDate topics and graphics on the management of increased intracranial pressure in children.Do you want to add Medilib to your home screen?