Metabolic and clinical markers of prognosis in the era of CT imaging in children with acute epidural hematomas

Acute epidural hematoma (AEH), a relatively common complication of head inj ury in children, persists in bearing high morbidity and mortality. Early es tablishment of prognosis could guide optimal patient allocation, and early identification of predictive signs could assist in choosing appropriate the rapeutic interventions. This study aimed to delineate expeditiously obtaina ble prognostic markers for determining outcome in a subset of children with AEH. We reviewed our 11-year experience with 61 consecutive children <16 y ears old with head trauma and isolated AEH. Treatment followed a standard a dvanced trauma life support protocol. A medical history was obtained, and a ll patients underwent neurosurgical and physical evaluations. CT scans were performed, as were laboratory tests which included arterial blood gases, g lucose, electrolytes (K+, Na+), hemoglobin and coagulation studies. Evaluat ion of the data collected on cause of injury, interval between trauma occur rence and presentation, clinical symptoms, Glasgow Coma Scale (GCS) scores, vital signs, laboratory test results, physical findings and surgical versu s conservative management revealed that the best single predictors of outco me following AEH were the GCS and focal neurological deficits. Of all labor atory data obtained on admission, the blood potassium, pH and glucose test results correlated significantly with prognosis. Prognosis can be adequatel y and expeditiously estimated by selected markers within a comprehensive ev aluation of children with AEH. Copyright (C) 2000 S. Karger AG, Basel.