Published in:
20-10-2022 | Subdural Hematoma | Commentary
Current issues and controversies surrounding spine imaging and the significance of spinal subdural hemorrhage in suspected abusive head trauma
Published in: Pediatric Radiology | Issue 13/2022
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Relatively little is known regarding the epidemiology of spinal injury in children with abusive head trauma (AHT), with much of the existing literature focusing on the cervical spine. However, recent attention has been paid to spinal subdural hemorrhage (SDH), particularly in the thoracolumbar region. Findings of several small single-center retrospective studies on spinal injuries in AHT (Table 1; [1‐6]) have prompted discussion among experts in child abuse about the need for well-powered multicenter hypothesis-driven studies to understand whether a causal association between events causing AHT and spinal SDH exists. Despite this increasing empirical database, the major professional societies have not developed consistent recommendations for spine imaging in children with AHT.
Table 1
Case series and retrospective studies examining spinal injuries in suspected abusive head trauma
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Publication
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Country
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Study design
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Findings
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|---|---|---|---|
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Rabbitt et al. 2020 [1]
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United States
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Single-center cross-sectional study
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Examined incidence of spinal injury on MRI among children <5 years undergoing evaluation for AHT
• Spine MRI performed in 47/61 children
• Spinal abnormalities in 29/47 (spinal SDH in 11)
• Vast majority (93%) of spinal MRIs obtained included only cervical spine through the T5 thoracic vertebrae
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|
Choudhary et al. 2012 [2]
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United States
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Single-center cross-sectional study
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Compared incidence and characteristics of spinal SDH in AHT vs. accidental trauma
• 252 children 0–2 years treated for AHT
• 67 children in AHT cohort had cross-sectional imaging (CT or MRI) of at least 1 spinal region
ο Spinal SDH in 31/67 (46%)
ο 38/67 had thoracolumbar imaging, with spinal SDH in 24/38 (>60%)
• Age-matched cohort of 70 children with accidental head injury, with spinal SDH in 1/70 (1%)
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|
Choudhary et al. 2014 [3]
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United States
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Single-center cross-sectional study
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Compared spinal neuroimaging (MRI) findings in 183 children <4 years
• AHT cohort = 67 children
ο Spinal SDH in 32/67 (48%)
ο Whole-spine MRI performed in 31 children, with spinal SDH in 21/31 (67%)
ο 56% of SDH at or below the thoracolumbar junction
• Accidental cohort = 46 children had spinal SDH in 1/46 (2%)
• Non-traumatic cohort = 70 children, spinal SDH in 0
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|
Kadom et al. 2014 [4]
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United States
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Single-center cross-sectional study
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Examined incidence of cervical spine and brain injuries in children <36 months evaluated for AHT with MRI
• 74 children
ο 26 with accidental head trauma
ο 38 with AHT (20 “suspicious,” 18 “presumptive”)
ο 10 with undefined head trauma
• Cervical spine injury present in 27/74 (36%), with ligamentous injury predominating
• Found a high incidence of cervical injury in children with bilateral hypoxic–ischemic brain injury
• Only a single child with spinal subdural hemorrhage
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|
Karmazyn et al. 2022 [5]
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United States
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Single-center cross-sectional study
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Examined whether whole-spine MRI identified injuries missed on cervical spine MRI among children <3 years evaluated for AHT
• Spinal SDH identified in 34/148 (23%) children who underwent whole-spine MRI
• 23/34 (68%) spinal SDHs were localized exclusively to the thoracolumbar spine
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Koumellis et al. 2009 [6]
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United Kingdom
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Single-center case series
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18 infants with AHT had dedicated MRI of brain and whole spine
• Years 1–4: whole-spine MRI restricted to cases with other findings suggestive of spinal injury, with spinal SDH in 2/7 (29%)
• Years 5–7: whole-spine MRI incorporated into evaluation of all cases of suspected AHT, with spinal SDH in 6/11 (55%)
• Hemorrhage at level of thoracic and lumbar spine predominated
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