Follow-up of Children after Surgical Evacuation of Extradural Haematomas: Getting it Right First Time

Abstract

Objective

Surgical outcomes for children with an extradural haematoma (EDH) can be excellent. However, neuropsychological outcomes of children after surgery for EDH are sparsely reported, and follow-up for these children is non-standardised. This study describes the follow-up and neuropsychological outcomes of a cohort of children who had surgery for an EDH.

Methods

Anonymised data were collated from a prospectively collected cohort of paediatric patients who underwent urgent surgery for EDH at a single neurosurgical centre from March 2007 to May 2021.

Results

Thirty-five patients were included in the study. Patients were aged between 5 months and 15 years. Almost all the patients (33/35; 94.2%) had a Glasgow Outcome Score (GOS) of 5 out of 5 upon hospital discharge. No deaths or recurrences were identified. Thirty patients (86%) received at least one follow-up review postoperatively; five patients (14%) had no documented follow-up. Forty percent (12/30) of patients who were followed up had neuropsychological concerns identified. Of these children, only four (33%) received formal neuropsychological review and treatment. Children with a low-presentation Glasgow Coma Scale (GCS) were more likely to develop neuropsychological issues (p = 0.045).

Conclusion

Children with EDHs can have good surgical outcomes. However, follow-up for these patients can be variable, which may be suboptimal for identifying the neuropsychological issues which can develop in children following head injury. In this study, children remain at risk even when the blood location is extra-axial, as in cases of EDH. All children should, therefore, receive formal follow-up and neuropsychological review after surgery for EDH.

Keywords

paediatric - extradural - haematoma - neuropsychology - follow-up

Ethical Approval Statement

This study was performed in line with the principles stated in the Declaration of Helsinki and the approval for the retrospective study was granted by the local South Wales Neuroscience Research and Audit Ethics Committee.

Publikationsverlauf

Eingereicht: 30. September 2024

Angenommen: 06. März 2025

Accepted Manuscript online:
03. April 2025

Artikel online veröffentlicht:
06. Mai 2025

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