The outcome of observation of acute traumatic extradural hemorrhage in pediatric age group

  • Mohammad Ahmad JamousEmail author
Original Article



The non-operative management of extradural hemorrhage in the pediatric age group has been increasingly considered in the last decade with good clinical outcomes and comparable results to surgical intervention in carefully selected patients. The purpose of this study is to evaluate the outcome of observation in the management of pediatric patients with extra dural hematoma.

Patients and methods

All consecutive pediatric patients with traumatic EDH after TBI who were presented to a single neurosurgical institution between January, 2008 and November, 2018 were retrospectively reviewed. Mechanism of injury, Glasgow coma scale (GCS) on admission, presenting neurological examination, treatment modality, the first and last imaging findings, and outcome were analyzed. The outcome was measured using the Glasgow outcome scale (GOS) on discharge from the hospital.


A total of 83 patients were identified. The median age was 7.1 years (0.8–14 years) and 67% of the patients were male (n = 56). The median thickness of acute EDH was 1.1 cm (0.2–2.6 cm).

44 patients were managed conservatively with a close observation at a specialized neurotrauma unit for any clinical deterioration, and the remaining 39 patients were managed surgically. There was no significant difference in the patients age, hematoma thickness, presence of skull fractures, systemic injuries, and other types of cerebral injuries between the two groups. The presenting GCS was significantly lower in the surgical group which reflects the severity of the injury. Hospital stay was significantly longer among the surgical group, and the GOS was significantly better in the non-surgical group.

The majority of the surgical group showed complete resolution of the hematoma on discharge, while only 50% of the non-surgical patients (n = 22) had a complete resolution of the hematoma one month after the TBI.


The conservative management is applicable in carefully selected pediatric patients with acute traumatic extradural hematoma provided that the observation is accomplished in a well-established and equipped neurosurgical unit. These results are congruent with similar earlier studies.


Extra dural hematoma Bleeding Pediatrics Children Conservative management 



Computed tomography


Extradural hematoma


Glasgow coma scale


Cerebrospinal fluid


Glasgow outcome score


Traumatic brain injury


Compliance with ethical standards

Conflict of interest

The author discloses no conflict of interest.

Ethical approval

This article is compliant with the ethical standards. It was not funded from any source.

Informed consent

Informed consent and ethical approval are not applicable for this article because of its retrospective nature.


  1. 1.
    Duhaime AC, Alario AJ, Lewander WJ, Schut L, Sutton LN, Seidl TS, Nudelman S, Budenz D, Hertle R, Tsiaras W, Loporchio S. Head injury in very young children: mechanisms, injury types, and ophthalmologic findings in 100 hospitalized patients younger than 2 years of age. Pediatrics. 1992;90:179–85.PubMedGoogle Scholar
  2. 2.
    McLaurin R. Towbin R Posttraumatic hematomas. In: McLaurin R, Schult L, Veres J, Epstein F, editors. Pediatric neurosurgery. 2nd ed. Philadelphia: Saunders; 1989. p. 277–289.Google Scholar
  3. 3.
    Binder H, Majdan M, Tiefenboeck TM, Fochtmann A, Michel M, Hajdu S, Mauritz W, Leitgeb J. Management and outcome of traumatic epidural hematoma in 41 infants and children from a single center. Orthop Traumatol Surg Res. 2016;102:769–74.CrossRefGoogle Scholar
  4. 4.
    Beni-Adani L, Flores I, Spektor S, Umansky F, Constantini S. Epidural hematoma in infants: a different entity? J Trauma Acute Care Surg. 1999;1999(46):306–11.CrossRefGoogle Scholar
  5. 5.
    Pang D, Horton JA, Herron JM, Wilberger JE Jr, Vries JK. Nonsurgical management of extradural hematomas in children. J Neurosurg. 1983;59:958–71.CrossRefGoogle Scholar
  6. 6.
    Knuckey NW, Gelbard S, Epstein MH. The management of “asymptomatic” epidural hematomas: a prospective study. J Neurosurg. 1989;1989(70):392–6.CrossRefGoogle Scholar
  7. 7.
    Chen TY, Wong CW, Chang CN, Lui TN, Cheng WC, Tsai MD, Lin TK. The expectant treatment of “asymptomatic” supratentorial epidural hematomas. Neurosurgery. 1993;1993(32):176–9.CrossRefGoogle Scholar
  8. 8.
    Pillay R, Peter JC. Extradural haematomas in children. S Afr Med J. 1995;1995(85):672–4.Google Scholar
  9. 9.
    Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, Servadei F, Walters BC, Wilberger JE. Surgical management of acute subdural hematomas. Neurosurgery. 2006;58:S2–16.CrossRefGoogle Scholar
  10. 10.
    Jamous MA, Aziz HA, Al Kaisy F, Eloqayli H, Azab M, Al-Jarrah M. Conservative management of acute epidural hematoma in a pediatric age group. Pediatr Neurosurg. 2009;45:181–4.CrossRefGoogle Scholar
  11. 11.
    Basamh M, Robert A, Lamoureux J, Saluja RS, Marcoux J. Epidural hematoma treated conservatively: when to expect the worst. Can J Neurol Sci. 2016;2016(43):74–81.CrossRefGoogle Scholar
  12. 12.
    Balmer B, Boltshauser E, Altermatt S, Gobet R. Conservative management of significant epidural haematomas in children. Childs Nerv Syst. 2006;2006(22):363–7.CrossRefGoogle Scholar
  13. 13.
    Paiva WS, Andrade AFD, Mathias Júnior L, Guirado VMDP, Amorim RL, Magrini NN, Teixeira MJ. Management of supratentorial epidural hematoma in children: report on 49 patients. Arq Neuropsiquiatr. 2010;68:888–92.CrossRefGoogle Scholar
  14. 14.
    Teichert JH, Rosales PR Jr, Lopes PB, Enéas LV, Da Rocha TS. Extradural hematoma in children: case series of 33 patients. Pediatr Neurosurg. 2012;48:216–20.CrossRefGoogle Scholar
  15. 15.
    Skadorwa T, Zygańska E, Eibl M, Ciszek B. Distinct strategies in the treatment of epidural hematoma in children: clinical considerations. Pediatr Neurosurg. 2013;2013(49):166–71.CrossRefGoogle Scholar
  16. 16.
    Flaherty BF, Moore HE, Riva-Cambrin J, Bratton SL. Pediatric patients with traumatic epidural hematoma at low risk for deterioration and need for surgical treatment. J Pediatr Surg. 2017;52:334–9.CrossRefGoogle Scholar
  17. 17.
    Champagne PO, He KX, Mercier C, Weil AG, Crevier L. Conservative management of large traumatic supratentorial epidural hematoma in the pediatric population. Pediatr Neurosurg. 2017;52:168–72.CrossRefGoogle Scholar
  18. 18.
    Bezircioglu H, Ersahin Y, Demircivi F, Yurt I, Donertas K, Tektas S. Nonoperative treatment of acute extradural hematomas: analysis of 80 cases. J Trauma Acute Care Surg. 1996;41:696–8.CrossRefGoogle Scholar
  19. 19.
    Salama MM, Eissa EM. Conservative management of extradural hematoma: experience with 70 cases. Egypt J Neurol Surg. 2010;25:185–94.Google Scholar
  20. 20.
    Mayr R, Troyer S, Kastenberger T, Krappinger D, Rosenberger R, Obwegeser A, El Attal R. The impact of coagulopathy on the outcome of traumatic epidural hematoma. Arch Orthop Trauma Surg. 2012;132:1445–500.CrossRefGoogle Scholar
  21. 21.
    Ding J, Yuan F, Guo Y, Chen SW, Gao WW, Wang G, Cao HL, Ju SM, Chen H, Zhang PQ, Tian HL. A prospective clinical study of routine repeat computed tomography (CT) after traumatic brain injury (TBI). Brain Inj. 2012;26:1211–6.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.King Abdullah University HospitalAr-RamthaJordan
  2. 2.Department of Neurosurgery, Faculty of MedicineJordan University of Science and TechnologyIrbidJordan

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