Abusive head trauma in children: radiographs of the skull do not provide additional information in the diagnosis of skull fracture when multiplanar computed tomography with three-dimensional reconstructions is available

Cosgrave, Laura; Bowie, Sarah; Walker, Cameron; Bird, Helen; Bastin, Sonja

doi:10.1007/s00247-021-05256-9

Cited by 4 publications

(3 citation statements)

References 16 publications

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“…Moreover, the diagnostic accuracy of CT with 3D reconstructions far exceeds that of radiographs in the diagnosis of skull fracture [45]. As such, skull radiographs could be excluded from the radiographic skeletal survey performed for suspected physical abuse in children less than 12 months of age given that they provide no further diagnostic information when CT with 3D reconstructions has, or is going to be, performed [45][46][47].…”

Section: What Are the Advantages And Disadvantages Of Ct?mentioning

confidence: 99%

Controversial aspects of imaging in child abuse: a second roundtable discussion from the ESPR child abuse taskforce

Paddock

Choudhary²,

Jeanes³

et al. 2023

Pediatr Radiol

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This second roundtable discussion was convened at the 56th European Society of Paediatric Radiology (ESPR) 2022 Annual Meeting in Marseille, France, to discuss controversial aspects of imaging in child abuse. The following topics were discussed: Fracture dating—the published literature is broadly similar with respect to the identification of the radiographic stages of bony healing. The non-expert/general radiologist is encouraged to use broad descriptors of fracture healing (acute, healing or old) within their reports, rather than attempting to date fractures. The more experienced/expert radiologist, who may provide a timeframe/range to assist the courts, should be aware that any published timeframes are not absolute and that recent research indicates that the rate of healing may differ according to the bone affected and the age of the patient. Whole spine imaging in suspected abusive head trauma—this is recommended to enable a complete assessment of the neuraxis when abusive head trauma is suspected or diagnosed, particularly in the presence of intracranial and cervical subdural haemorrhage and cervical ligamentous injury. Cranial imaging in suspected physical abuse—both computed tomography (CT) and magnetic resonance imaging (MRI) remain complimentary depending on the clinical context in which they are used with CT remaining first-line in the assessment of children with (suspected abusive) head trauma prior to an early MRI. MRI is superior in its assessment of parenchymal injury and may be employed as first-line in age appropriate asymptomatic siblings of a child with suspected physical abuse.

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Section: What Are the Advantages And Disadvantages Of Ct?mentioning

confidence: 99%

Controversial aspects of imaging in child abuse: a second roundtable discussion from the ESPR child abuse taskforce

Paddock

Choudhary²,

Jeanes³

et al. 2023

Pediatr Radiol

View full text Add to dashboard Cite

show abstract

“…The effects of AHT are catastrophic, as it is the leading cause of mortality and morbidity in children under the age of two years; AHT produces situations of marked long-term physical and intellectual disability, such as convulsions, cerebral palsy, and intellectual and learning deficits due to the severe encephalic lesions produced by the trauma, leading to death in about a third of cases [ 18 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

‘Compressed Baby Head’: A New ‘Abusive Head Trauma’ Entity?

Macorano,

Gentile,

Stellacci

et al. 2023

Children

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Background: Child abuse represents an important issue in the medico-legal and social context. In the last few decades, various aspects and mechanisms have been identified in child abuse case studies; however, constant research is needed in the field. With this paper, the authors will present a case of a new entity of Abusive Head Trauma that has come to the attention of medico-legal experts. Discussion: The trauma analysis performed on the cranio-encephalic district of the baby revealed quite peculiar lesions that led the authors to exclude that the injuries had been solely caused by violent shaking of the baby’s head, as suggested by Shaken Baby Syndrome. Instead, the authors hypothesised that another lesion mechanism had been added to this one, namely latero-lateral cranial compression. The comprehensive and exhaustive analysis of the case led the authors to present a new possible entity in child abuse trauma, namely ‘Compressed Baby Head’. Conclusions: To the best of our knowledge, in the current literature, no similar clinical cases have ever been described. Thus, the case’s uniqueness deserves to be brought to the attention of experts and the entire scientific community, as well as medical personnel, paediatricians, and reanimators. These professional figures are the first individuals who may encounter complex clinical cases such as the one presented in this paper; thus, they need to know how to properly manage the case and ensure protection for the abused infants and children.

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“…The reported mortality rate of babies with AHT ranges from 10% to 30%. Two-thirds of survivors suffer from serious long-term disabilities [ 3 ]. Those disabilities include seizures, cerebral palsy, cortical blindness, and behavior, intellectual, and learning problems resulting from a secondary brain injury by hypoxia, ischemia, or inflammation [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Neonatal Abusive Head Trauma without External Injuries: Suspicion Improves Diagnosis

et al. 2022

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The term “shaken baby syndrome” has been replaced by “abusive head trauma (AHT)” based on the mechanism of injury. The reported mortality rate of AHT ranges from 10% to 30%. Up to two-thirds of survivors suffer from serious long-term disabilities. Thus, an expeditious and accurate diagnosis is crucial to prevent further abuse that might result in death or serious disabilities. It remains a challenge for physicians to diagnose AHT when parents do not give a history of trauma in preverbal infants without any external signs. Here, we report a case of a 14-day-old boy who presented with a febrile convulsion without evident external injuries nor history of trauma according to his parents. He was diagnosed with AHT based on MRI findings of subacute subdural hemorrhage, multiple cortical hemorrhages, cerebral edema, and diffuse axonal injury. In conclusion, health care providers should keep in mind that the history of trauma provided by the parents or caregivers might not always be true and that reasonable suspicion of abuse is the most important in the diagnosis of AHT, although neuroimaging plays a pivotal role. Reasonable suspicion of AHT in combination with a thorough physical examination, neuroimaging, and skilled neuroradiologist can improve diagnosis and help victims in a timely manner.

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Abusive head trauma in children: radiographs of the skull do not provide additional information in the diagnosis of skull fracture when multiplanar computed tomography with three-dimensional reconstructions is available

Cited by 4 publications

References 16 publications

Controversial aspects of imaging in child abuse: a second roundtable discussion from the ESPR child abuse taskforce

Controversial aspects of imaging in child abuse: a second roundtable discussion from the ESPR child abuse taskforce

‘Compressed Baby Head’: A New ‘Abusive Head Trauma’ Entity?

Neonatal Abusive Head Trauma without External Injuries: Suspicion Improves Diagnosis

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