Abusive Head Trauma: Judicial Admissions Highlight Violent and Repetitive Shaking

Adamsbaum, C.; Grabar, Sophie; Mejean, N.; Rey-Salmon, Caroline

doi:10.1542/peds.2009-3647

Cited by 286 publications

(203 citation statements)

References 25 publications

(27 reference statements)

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“…131 Confessions from some perpetrators have highlighted the often repetitive nature of the abuse, and the crying of an infant as a common impetus for the violence. 69,132 Compared with children with severe accidental trauma, children with AHT are more likely to have subdural hemorrhage, retinal hemorrhages, and associated cutaneous, skeletal, and visceral injuries. 97,[133][134][135][136] Inflicted injuries tend to occur in younger patients and result in higher mortality and longer hospital stays than does accidental head trauma.…”

Section: Head Injuriesmentioning

confidence: 99%

The Evaluation of Suspected Child Physical Abuse

Christian¹

2015

Pediatrics

448

301

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Child physical abuse is an important cause of pediatric morbidity and mortality and is associated with major physical and mental health problems that can extend into adulthood. Pediatricians are in a unique position to identify and prevent child abuse, and this clinical report provides guidance to the practitioner regarding indicators and evaluation of suspected physical abuse of children. The role of the physician may include identifying abused children with suspicious injuries who present for care, reporting suspected abuse to the child protection agency for investigation, supporting families who are affected by child abuse, coordinating with other professionals and community agencies to provide immediate and long-term treatment to victimized children, providing court testimony when necessary, providing preventive care and anticipatory guidance in the office, and advocating for policies and programs that support families and protect vulnerable children.

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Section: Head Injuriesmentioning

confidence: 99%

The Evaluation of Suspected Child Physical Abuse

Christian¹

2015

Pediatrics

448

301

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“…This was a strong supplemental argument for AHT since retinal hemorrhages have been considered in previous reports as specific signs of abuse from a shaking mechanism when associated with SDH in neonates and toddlers without a clear history of trauma. 1,[8][9][10][12][13][14]16,19,22,[24][25][26]29 SDH is the most common finding on cranial CT scans of patients who are victims of AHT (present in > 70% of cases); 2,3,7,8,23 it is commonly bilateral and sometimes associated with interhemispheric hyperdensity and/or convexity hemorrhages 3,7,8,30 as we found in our sample. The SDHs in our patients were sometimes exclusively hyperdense (acute) or heterogeneous (acute and subacute), due to the natural sedimentation, accumulation of CSF and hemoglobin oxidation in different stages, or were homogeneously hypodense as described by some authors.…”

Section: Discussionmentioning

confidence: 61%

Surgical options for treatment of traumatic subdural hematomas in children younger than 2 years of age

Melo

Rocco²,

Bourgeois³

et al. 2014

PED

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Object Subdural hematoma (SDH) is the most common finding on cranial CT in pediatric victims of abusive head trauma (AHT). The hematomas are commonly bilateral and sometimes associated with interhemispheric hyperdensity and/or convexity hemorrhages. There is no consensus regarding the best surgical treatment in such cases nor are there standardized surgical protocols. The authors report their experience and discuss the routine surgical options in the management of traumatic SDH at a Level 1 Pediatric Trauma Center. Methods In this paper, the authors describe a cross-sectional study with consecutive revision of data described in the medical records of Hôpital Universitaire Necker–Enfants Malades between January 2008 and January 2013. During this period, all children younger than 2 years of age who were admitted with a traumatic SDH identified on CT scans were included in this study. Results One hundred eighty-four children who had SDH and were younger than 2 years of age were included. Their median age was 5.8 months (range 5 days–23 months), and 70% of the children were male. On admission CT scans, the SDH was bilateral in 52% of cases and homogeneously hypodense in 77%. Neurosurgical treatment was undertaken in 111 children (60%) with an admission Glasgow Coma Scale score of 12 or less, bulging fontanels, or other signs suggestive of intracranial hypertension. The first surgical option was craniotomy in 1.8% (2) of these 111 cases, decompressive craniectomy in 1.8% (2), transcutaneous subdural puncture in 15% (17), external subdural drainage in 16% (18), subdural-subgaleal shunt placement in 17% (19), and subdural-peritoneal shunt placement in 48% (53). In 82% of the children initially treated with transcutaneous subdural puncture and in 50% of those treated with external subdural drainage, increase or persistence of the SDH, CSF or skin infection, or shunt system malfunction was observed and further surgical intervention was required. There was a 26% rate of complications in patients initially treated with a subdural-peritoneal shunt. Although 52% of the patients had bilateral SDH, bilateral drainage was only required in 9.4%. Conclusions The choice of treatment should be determined by the clinical and radiological characteristics of the individual case. Although effective on an emergency basis, subdural puncture and external subdural drainage are frequently insufficient to obtain complete resolution of SDH, and temporary placement of a subdural-peritoneal shunt is needed in most cases.

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“…Such an "age-different" pattern is important to recognize, given that shakings are often repeated. 2 In our opinion, the head circumference is a key sign-when available-that a subdural collection may be related to a previous subdural hematoma and therefore to a previous episode of shaking. Therefore, we disagree with the authors' conclusion that "the SDHy in this well-documented case can be regarded as a result of acute injury," and we believe that this is a case of repeated shaking.…”

mentioning

confidence: 94%