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

Abstract 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. 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. 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). 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.