The following is a summary of “Complete Neurological Recovery After Emergency Burr Hole Placement Utilizing EZ-IO® for Epidural Hematoma” published in the October 2022 issue of Emergency Medicine by Grossman et al.
Epidural hematoma (EDH) is a common complication after closed head trauma in children (1-3% of hospitalizations). Males outnumber females by a ratio of 2.5 to 1. The most common cause of EDH in teens is car accidents. Up to 4% of adult head traumas are accompanied by post-traumatic EDH, and it’s linked to 10% mortality in adults and 5% mortality in children. Decompressive craniotomy or trepanation through a burr hole is the gold standard treatment for post-traumatic EDH in North America. Such potentially life-saving treatment is often administered in the operating room by neurosurgeons on call or other medical professionals familiar with burr hole technology.
A female patient, aged 17, was involved in a car accident and sought care at a local ED. She declined EMS transport at the scene of the collision and was driven privately to the ER. She went into acute respiratory distress in the ED and immediately needed intubation. Weather caused a delay in transfer to the nearest pediatric trauma facility, where neurosurgical services were unavailable. The EDH was decompressed and drained using an EZ-IO® driver and intraosseous needle under the supervision of a virtual pediatric neurosurgeon.
The patient’s neurological symptoms resolved entirely. Mortality and morbidity rates are high in EDHs. Until definitive neurosurgical care can be acquired, the EZ-IO® device may be a lifesaving interim measure in settings lacking access to neurosurgical services and where ED access to or experience with burr hole equipment is restricted.