Occult head injury is common in children with concern for physical abuse

Pediatr Radiol. 2018 Aug;48(8):1123-1129. doi: 10.1007/s00247-018-4128-6. Epub 2018 Apr 13.

Abstract

Background: Studies evaluating small patient cohorts have found a high, but variable, rate of occult head injury in children <2 years old with concern for physical abuse. The American College of Radiology (ACR) recommends clinicians have a low threshold to obtain neuroimaging in these patients.

Objectives: Our aim was to determine the prevalence of occult head injury in a large patient cohort with suspected physical abuse using similar selection criteria from previous studies. Additionally, we evaluated proposed risk factors for associations with occult head injury.

Materials and methods: This was a retrospective, secondary analysis of data collected by an observational study of 20 U.S. child abuse teams that evaluated children who underwent subspecialty evaluation for concern of abuse. We evaluated children <2 years old and excluded those with abnormal mental status, bulging fontanelle, seizure, respiratory arrest, underlying neurological condition, focal neurological deficit or scalp injury.

Results: One thousand one hundred forty-three subjects met inclusion criteria and 62.5% (714) underwent neuroimaging with either head computed tomography or magnetic resonance imaging. We found an occult head injury prevalence of 19.7% (141). Subjects with emesis (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.8-6.8), macrocephaly (OR 8.5, 95% CI 3.7-20.2), and loss of consciousness (OR 5.1, 95% CI 1.2-22.9) had higher odds of occult head injury.

Conclusion: Our results show a high prevalence of occult head injury in patients <2 years old with suspected physical abuse. Our data support the ACR recommendation that clinicians should have a low threshold to perform neuroimaging in patients <2 years of age.

Keywords: Abusive head trauma; Children; Computed tomography; Magnetic resonance imaging; Neuroimaging; Non-accidental trauma.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Child Abuse / diagnosis*
  • Child Abuse / statistics & numerical data
  • Craniocerebral Trauma / diagnostic imaging*
  • Craniocerebral Trauma / epidemiology
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Magnetic Resonance Imaging
  • Male
  • Neuroimaging / methods*
  • Prevalence
  • Retrospective Studies
  • Risk Factors
  • Tomography, X-Ray Computed
  • United States / epidemiology