Abstract:
BACKGROUND: Acute traumatic epidural hematoma (EDH) is a complication in 2-3% of pediatric head injuries. Surgery is mandatory in symptomatic cases; otherwise, conservative treatment is a valid approach, especially in the pediatric population. Ossified epidural hematomas (OEHs) have been reported in the pediatric population as a rare complication of conservative EDH management, although the exact incidence remains unknown. The progressive increase in conservative management may lead to increases in the OEH incidence over the next few years. Our study aimed to systematically review OEH incidence, management strategies, characteristics (thickness, inner/outer calcifications), complication rates, time to surgery after the EDH diagnosis, and clinical outcomes.
CONCLUSIONS: A systematic review was conducted in accordance with the PRISMA guidelines. Studies reporting diagnoses and clear descriptions of OEH after EDH in pediatric patients were considered eligible. Sixteen studies, including 18 pediatric patients aged 0-18 years, were included. Head trauma was the most common cause of OEH. Seven (38.8%) OEHs were treated less than 1 month after EDH diagnosis. Surgery was performed in 17 cases (94.44%), while 1 asymptomatic case (5.56%) was managed conservatively.
CONCLUSIONS: Surgery was the most commonly used treatment for OEH. Data for conservative treatment of OEH are limited. Magnetic resonance imaging or ultrasound within the first 2 months, to check for EDH resolution, may be crucial to rule out complications in pediatric patients.
摘要:
背景:急性外伤性硬膜外血肿(EDH)是2-3%小儿头部损伤的并发症。在有症状的情况下必须手术;否则,保守治疗是一种有效的方法,尤其是在儿科人群中。据报道,在儿科人群中,骨化的硬膜外血肿(OEHs)是保守EDH治疗的罕见并发症。尽管确切的发病率仍然未知。保守管理的逐步增加可能导致未来几年OEH发病率的增加。我们的研究旨在系统地回顾OEH的发病率,管理策略,特性(厚度,内/外钙化),并发症发生率,EDH诊断后的手术时间,和临床结果。
结论:根据PRISMA指南进行系统评价。在儿科患者中EDH后报告OEH的诊断和明确描述的研究被认为是合格的。16项研究,包括18名0-18岁的儿科患者,包括在内。头部外伤是OEH的最常见原因。在EDH诊断后不到1个月,治疗了7例(38.8%)OEHs。手术17例(94.44%),1例无症状病例(5.56%)得到保守治疗。
结论:手术是最常用的OEH治疗方法。保守治疗OEH的数据有限。前2个月内的磁共振成像或超声检查,要检查EDH分辨率,对于排除儿科患者的并发症可能至关重要。