Papers Presented at the 4th Western Pediatric Trauma Conference Snowmass, Colorado, July 2016Pediatric patients with traumatic epidural hematoma at low risk for deterioration and need for surgical treatment

BackgroundAlthough some pediatric patients with small traumatic epidural hematoma (EDH) are observed without surgical drainage, clinical practice remains variable.ObjectivesCreate a prediction rule to identify patients with EDH unlikely to fail hospital observation.MethodsRetrospective review at a level I pediatric trauma center between 2003 and 2014. Presenting clinical and radiographic features were compared between those successfully to failed observation.ResultsTwo hundred twenty-two patients with EDH whose initial management strategy was observation were analyzed; 196 (88%) were successfully observed. The group failing observation was more likely to present with altered mental status (RR 18.8; 95% CI 8.7-49.6), has larger median bleed thickness (observed = 5.6 mm versus failed observation = 10.9 mm, p < 0.01), median bleed volume (observed = 2.1 ml versus failed observation = 15.7 ml, p < 0.01), and mass effect (RR 3.7; 95% CI 1.8-7.7). No mass effect, EDH volume < 15 ml, and no neurologic deficits predicted patients at low risk of failing observation with a positive predictive value of 98% (95% CI 93-99%). There was no difference in median discharge Glasgow outcome scores (5 in both groups, p = 0.20).ConclusionPatients with no mass effect and EDH volume < 15 ml on initial CT scan and no neurologic deficit are at low risk of failing observation.Level of evidenceRetrospective cohort level I.