in 7 cases (24.1%), parietal and occipital in 4 cases respectively (13.7%) (Fig. 2). The locations of hematoma were almost same in both sides (left side 15 cases). The mean thickness of the he- matoma was 18 mm (range, 5-40 mm), and 14 patients (48.2%) showed midline shift in initial imaging. Twenty-four patients (82.5%) had an associated skull fracture. Five patients had cere- bral contusion. Three patients underwent MRI after the treat- ment of the EDH, and 1 patient showed signs of DAI. Hetero- geneous hematomas in CT scans were 20 cases (68.9%). Among these cases, 6 cases showed enlargement of hematoma in fol- low-up CT scans. Clinical outcome None of the patients in this series died of EDH (0% mortali- ty). In this study, only one patient died. He was 1-year-old and fell down on the kitchen floor. When he arrived at the hospital, he was in cardiac arrest. His CT scan showed small amount of EDH in right temporal area. Finally, he died due to hypoxic brain damage and hemoperitoneum. Except this case, no patient died of EDH. The overall outcomes were excellent in 26 patients (92.8%) and good in 2 patients (7.2%). DISCUSSION Incidence of epidural hematoma in children was scarcer than that in adults due to tight adherence of the dura to the inner ta- ble of the skull10). In other studies, of all head-injured admitted children under 15 years of age admitted, 2-3% were found to have extradural hematomas7). But in our study, 32.6% of all ad- mitted head-injured children (57 of 175) had EDHs. A possible explanation for this difference might be found in the difference of cause of trauma. In other studies, the most common cause was fall down. But in our study, it was traffic accident. Children sustaining cranial traumas associated with EDH rep- resent a heterogeneous group with various clinical outcomes. The approximated mortality is 5%, although mortality in the quoted literature ranges from 0% to 12%, and was even higher in the pre-CT era3,5,11). In our study, mortality was zero, 26 cases had excellent out- come. Only 2 cases had good outcome. A possible explanation Fig. 2. Location and sde of all EDHs. EDHs : epidural hematomas. 217 Outcome in Surgically Treated EDHs | SW Jung and DW Kim for the overall very good outcome might be the advanced con- temporary pediatric trauma care and urgent surgery in patients with clinical signs of uncal herniation. There was significant difference between children and adults in the clinical course. 20-30% of adult patients were unconscious (GCS <8). However, only 3% of children in our study were un- conscious. It was in concordance with other studies1,4,7-13). Prognostic factors of EDH in children are GCS, pupillary re- action and light response, and the presence of focal neurological deficit, the laboratory findings of hyperglycemia and hypokale- mia5). These are similar to those in adults3). But, mortality of EDH in children is lower than that of adult10). Such a good out- come in children is probably related to the significantly lower in- cidence of associated intradural injury and the lower incidence of unconsciousness of patients requiring immediate surgery10). The criteria for determining which cases for conservative and which cases for surgical treatment remained controversial. Bejj- ani et al.5) found that the most important radiographic parameter dictating surgical evacuation was maximum diameter of hemato- ma of more than 15 mm and midline shift of more than 5 mm. Only patients with EDHs less than 10 mm and no focal deficits were treated conservatively and followed up closely, but if any de- terioration occurred and/or an increase in the size of the hemato- ma was seen, we decided to perform a surgical evacuation. It was reported that the incidence of skull fracture in children was 60-82% and it was known that there was no difference in that of adult6,7,9,10,13). In our study, the incidence of skull fracture was 82.5% and it corresponded to reported literature. The mean time to surgical intervention was 23 hours. Surgery was performed within 24 hours in about 80% of adults, but only in 54% of children. It is thought that it was because of in- sidious clinical course of EDH in children7,10). The heterogeneous hematoma appearances of some actively bleeding extradural hematomas have been termed the “swirl sign”2). In our study, 70.0% (20 of 29) had the “swirl sign”. Six of 20 patients showed increased hematoma volume in follow-up CT scans. This study was retrospective and included a small number of patients. Therefore, we could not show statistically meaningful factor which affected prognosis. But, our good outcome may be Cerebellum, 1 Site Occipital, 4 Parietal, 4 Frontal, 7 Temporal, 13 Left 52% Right 48%