Epidural hematoma in infants: A different entity?

Background: Epidural hematoma (EDH) in infants may be difficult to diagnose. The mechanism of injury and the clinical presentation are different from those in older children. We characterized the clinical and radiologic parameters of EDH in infants and correlated them with outcome. Because there are no optimal prognostic tools or clear guidelines to perform computed tomography in this unique population, a new approach of neurotrauma scoring is suggested. Methods: Eleven infants (<2 years old) operated on for EDH were studied. Children's Glasgow Coma Scale (CCS) score was applied, and diagnosis was confirmed by computed tomography. Results: Age was 13 ± 5 months. Seven infants (63.6%) fell from less than 1 m. CCS score on admission was 10.7 ± 3.9. Five infants (45%) were unconscious, yet two (18.2%) had CCS scores of 15. Pupillary abnormalities were found in two infants and lateralizing signs in five infants. Eight infants (72.7%) had subgaleal hematomas. Mortality and morbidity were 9% each. Conclusion: We suggest that a Trauma Infant Neurologic Score be used when dealing with EDH in infants. Lateralizing signs, pupillary abnormalities, mechanism of trauma, and scalp injuries should be included because these are objective relevant parameters.