Surgical Intervention Versus Observation for Pediatric Patients with Epidural Hematomas

Introduction Epidural hematomas (EDH) are a potentially lethal complication of closed head injury ocurring in 3% of head traumas. While classical practice was once to evacuate all EDH, the advent of CT imaging identified numerous EDH patients with minimal or no clinical symptoms. In the CT scan era, operative rates for pediatric EDH range widely, from 20-70%. Research on adult EDH provides guidelines for which patients with EDH can be managed without surgery GCS >8, EDH thickness < 15mm, EDH volume < 30mL, midline shift < 5ml, no focal neurological deficits. However, similar guidelines are lacking in the pediatric literature.