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01-11-2014 | Original Article

Head injury pattern in children can help differentiate accidental from non-accidental trauma

Authors: Jonathan P. Roach, Shannon N. Acker, Denis D. Bensard, Andrew P. Sirotnak, Frederick M. Karrer, David A. Partrick

Published in: Pediatric Surgery International | Issue 11/2014

Abstract

Objectives

Our aim was to define the radiographic findings that help differentiate abusive head trauma (AHT) from accidental head injury.

Methods

Our trauma registry was queried for all children ≤5 years of age presenting with traumatic brain injury (TBI) from 1996–2011.

Results

Of 2,015 children with TBI, 71 % had accidental injury and 29 % had AHT. Children with AHT were more severely injured (ISS 22.1 vs 14.4; p < 0.0001) and had a higher mortality rate (15 vs 5 %; p < 0.0001). Patients with AHT had higher rates of diffuse axonal injury (14 vs 8 %; p < 0.0001) and subdural hemorrhage (76 vs 23 %; p < 0.0001). Children with accidental injury had higher rates of skull fractures (52 vs 21 %; p < 0.0001) and epidural hemorrhages (11 vs 3 %).

Conclusions

AHT occurred in 29 % of children and resulted in increased mortality rates. These children had higher rates of subdural hemorrhages and diffuse axonal injury. Physicians initially evaluating injured children must maintain a high index of suspicion for abuse in those who present with subdural hematoma or diffuse axonal injury.

Kempe C, Silverman F, Steele B et al (1962) The battered-child syndrome. JAMA 181:17–24PubMedCrossRef

Roaten J, Partrick D, Nydam T et al (2006) Nonaccidental trauma is a major cause of morbidity and mortality among patients at a regional level 1 pediatric trauma center. J Pediatr Surg 41:1213–1215CrossRef

Ewing-Cobbs L, Prasad M, Kramer L et al (2000) Acute neuroradiographic findings in young children with inflicted or noninflicted traumatic brain injury. Childs Nerv Syst 16:25–34PubMedCrossRef

Keenan H, Runyan D, Marshall S et al (2003) A population-based study of inflicted traumatic brain injury in young children. JAMA 290:621PubMedCrossRef

Tung G, Kumar M, Richardson R et al (2006) Comparison of accidental and nonaccidental traumatic head injury in children on noncontrast computed tomography. Pediatrics 118:626–633PubMedCrossRef

Vinchon M, Defoort-Dhellemmes S, Desurmont M et al (2005) Accidental and nonaccidental head injuries in infants: a prospective study. J Neurosurg 102:380–384PubMed

Arbogast K, Margulies S, Christian C (2005) Initial neurologic presentation in young children sustaining inflicted and unintentional fatal head injuries. Pediatrics 116:180–184PubMedCrossRef

Flaherty E, Sege R (2005) Barriers to physician identification and reporting of child abuse. Pediatr Ann 34:349–356PubMedCrossRef

Barsness K, Cha E, Bensard D et al (2003) The positive predictive value of rib fractures as an indicator of nonaccidental trauma in children. J Trauma 54:1107–1110PubMedCrossRef

10.

Bonnier C, Marique P, Van Hout A et al (2007) Neurodevelopmental outcome after severe traumatic brain injury in very young children: role for subcortical lesions. J Child Neurol 22:519–529PubMedCrossRef

11.

Ewing-Cobbs L, Kramer L, Prasad M et al (1998) Neuroimaging, physical, and developmental findings after inflicted and noninflicted brain injury in young children. Pediatrics 102:300–307PubMedCrossRef

12.

Fujiwara T, Okuyama M, Miyasaka M (2008) Characteristics that distinguish abusive from nonabusive head trauma among young children who underwent computed tomography in Japan. Pediatrics 122:e000CrossRef

13.

Chang D, Knight V, Ziegfeld S et al (2004) The tip of the iceberg for child abuse: the critical roles of the pediatric trauma service and its registry. J Trauma 57:1189–1198PubMedCrossRef

14.

Acker SN, Ross J, Partrick DA et al (2014) Head injury and unclear mechanism of injury: initial hematrocrit less than 30 is predictive of abusive head trauma in young children. J Pediatr Surg 49(2):338–340PubMedCrossRef

15.

Oehmichen M, Meissner C, Saternus K (2005) Fall or shaken: traumatic brain injury in children caused by falls or abuse at home—a review on biomechanics and diagnosis. Neuropediatrics 36:240–245PubMedCrossRef

16.

Hahn Y, Raimondi A, McLone D et al (1983) Traumatic mechanisms of head injury in child abuse. Childs Brain 10:229–241PubMed

17.

Chiesa A, Duhaime Ac (2009) Abusive head trauma. Pediatr Clin North Am 56(2):317–331PubMedCrossRef

Title: Head injury pattern in children can help differentiate accidental from non-accidental trauma
Authors: Jonathan P. Roach
Shannon N. Acker
Denis D. Bensard
Andrew P. Sirotnak
Frederick M. Karrer
David A. Partrick
Publication date: 01-11-2014
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Surgery International / Issue 11/2014
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-014-3598-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Head injury pattern in children can help differentiate accidental from non-accidental trauma

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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