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. 2018 May;141(5):e20173485.
doi: 10.1542/peds.2017-3485.

Relevance of Abusive Head Trauma to Intracranial Hemorrhages and Bleeding Disorders

James D Anderst  1 , Shannon L Carpenter  2 , Rodney Presley  3 , Molly Curtin Berkoff  4 , Allison P Wheeler  5 , Robert F Sidonio Jr  6 , J Michael Soucie  7
Affiliations

Relevance of Abusive Head Trauma to Intracranial Hemorrhages and Bleeding Disorders

James D Anderst et al. Pediatrics. 2018 May.

Abstract

Background: Bleeding disorders and abusive head trauma (AHT) are associated with intracranial hemorrhage (ICH), including subdural hemorrhage (SDH). Because both conditions often present in young children, the need to screen for bleeding disorders would be better informed by data that include trauma history and are specific to young children. The Universal Data Collection database contains information on ICH in subjects with bleeding disorders, including age and trauma history. Study objectives were to (1) characterize the prevalence and calculate the probabilities of any ICH, traumatic ICH, and nontraumatic ICH in children with congenital bleeding disorders; (2) characterize the prevalence of spontaneous SDH on the basis of bleeding disorder; and (3) identify cases of von Willebrand disease (vWD) that mimic AHT.

Methods: We reviewed subjects <4 years of age in the Universal Data Collection database. ICH was categorized on the basis of association with trauma. Prevalence and probability of types of ICH were calculated for each bleeding disorder.

Results: Of 3717 subjects, 255 (6.9%) had any ICH and 206 (5.5%) had nontraumatic ICH. The highest prevalence of ICH was in severe hemophilia A (9.1%) and B (10.7%). Of the 1233 subjects <2 years of age in which the specific location of any ICH was known, 13 (1.1%) had spontaneous SDH (12 with severe hemophilia; 1 with type 1 vWD). The findings in the subject with vWD were not congruent with AHT.

Conclusions: In congenital bleeding disorders, nontraumatic ICH occurs most commonly in severe hemophilia. In this study, vWD is not supported as a "mimic" of AHT.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Drs Anderst, Berkoff, and Carpenter have provided expert consultation for the prosecution and defense in cases of alleged child abuse; the other authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Analysis of study subjects.
FIGURE 2
FIGURE 2
Head computed tomography scan of the single subject with type 1 vWD and spontaneous SDH.
See this image and copyright information in PMC

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