Computed Tomography of Craniocerebral Injury in the Abused Child

Zimmerman, Robert A.; Bilaniuk, Larissa T.; Bruce, Derek A.; Schut, Luis; Uzzell, Barbara P.; Goldberg, Herbert I.

doi:10.1148/130.3.687

Cited by 154 publications

(54 citation statements)

References 10 publications

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“…All of our patients under 2 years of age had abnormal cranial CT scans. The incidence of intracranial abnormalities by CT ranges from 7% of a large unselected group to 96% of a selected group of abused children [3,7]. In our patients we found a very high incidence of intracranial abnormalities on both initial scans (95%) and follow-up scans (96% The falx cerebri appears prominent when there is diffuse cerebral edema.…”

Section: Crania! Sonographymentioning

confidence: 50%

See 1 more Smart Citation

Cranial computed tomography in the abused child with head injury

Cohen¹,

Kaufman²,

Myers³

et al. 1986

American Journal of Roentgenology

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Section: Crania! Sonographymentioning

confidence: 50%

“…Previous reports of cranial CT of abused children have demonstrated a wide spectrum of abnormalities, but the examinations were performed primarily on early-generation scanners [3][4][5]. We have studied 37 abused children by cranial CT.…”

Section: American Roentgen Ray Societymentioning

confidence: 99%

Cranial computed tomography in the abused child with head injury

Cohen¹,

Kaufman²,

Myers³

et al. 1986

American Journal of Roentgenology

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“…Reversal sign referred to a CT scan on which the cerebral cortex was less dense than the basal ganglia and/or posterior fossa. 36,38 Encephalomalacia was defined as a focal loss of brain volume, whereas atrophy referred to a global loss of brain volume.…”

Section: Methodsmentioning

confidence: 99%

Serial neuroimaging in infants with abusive head trauma: timing abusive injuries

Bradford¹,

Choudhary²,

Dias

2013

PED

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Object The appearance and evolution of neuroimaging abnormalities following abusive head trauma (AHT) is important for establishing the time frame over which these injuries might have occurred. From a legal perspective this frames the timing of the abuse and therefore identifies and excludes potential perpetrators. A previous pilot study involving 33 infants with AHT helped to refine the timing of these injuries but was limited by its small sample size. In the present study, the authors analyzed a larger group of 210 cases involving infants with AHT to chronicle the first appearance and evolution of radiological (CT, MRI) abnormalities. Methods All children younger than 24 months admitted to the Penn State Hershey Medical Center with AHT over a 10-year period were identified from a medical record review; the time of injury was determined through an evaluation of the clinical records. All imaging studies were analyzed, and the appearance and evolution of abnormalities were chronicled on serial neuroimaging studies obtained in the days and weeks after injury. Results One hundred five infants with specific injury dates and available imaging studies were identified; a subset of 43 children additionally had documented times of injury. In infants with homogeneously hyperdense subdural hematomas (SDHs) on initial CT scans, the first hypodense component appeared within the SDH between 0.3 and 16 days after injury, and the last hyperdense subdural component disappeared between 2 and 40 days after injury. In infants with mixed-density SDHs on initial scans, the last hyperdense component disappeared between 1 and 181 days. Parenchymal hypodensities appeared on CT scans performed as early as 1.2 hours, and all were visible within 27 hours after the injury. Rebleeding into SDHs was documented in 17 cases (16%) and was always asymptomatic. Magnetic resonance imaging of the brain was performed in 49 infants. Among those with SDH, 5 patterns were observed. Patterns I and II reflected homogeneous SDH; Pattern I (T1 hyperintensity and T2/FLAIR hypointensity, “early subacute”) more commonly appeared on scans performed earlier after injury compared with Pattern II (T1 hyperintensity and T2/FLAIR hyperintensity, “late subacute”), although there was considerable overlap. Patterns III and IV reflected heterogeneous SDH; Pattern III contained relatively equal mixtures having different intensities, whereas Pattern IV had fluid that was predominantly T1 hypointense and T2/FLAIR hyperintense. Again, Pattern III more commonly appeared on scans performed earlier after injury compared with Pattern IV, although there was significant overlap. Conclusions These data extend the preliminary data reported by Dias and colleagues and provide a framework upon which injuries in AHT can be timed as well as the limitations on such timing estimates.

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“…Shaken infant syndrome is the most widely used and recognized term, although shaking alone may not account for all injuries. 3 Whatever the terminology and pathogenesis, abusive head injuries among infants represent one of the most severe forms of child abuse, with 13 to 30% mortality rates 4,5,7,8 and significant neurologic impairments in at least one half of the survivors. 9 The economic costs of abusive head injuries are significant; initial inpatient hospitalization costs average $18 000 to $70 000 per child, and average ongoing medical costs can exceed $300 000 per child.…”

mentioning

confidence: 99%

Preventing Abusive Head Trauma Among Infants and Young Children: A Hospital-Based, Parent Education Program

Dias¹,

Smith²,

deGuehery³

et al. 2005

Pediatrics

310

216

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ABSTRACT. Objective. Abusive head injuries among infants (shaken infant or shaken impact syndrome) represent a devastating form of child abuse; an effective prevention program that reduces the incidence of abusive head injuries could save both lives and the costs of caring for victims. We wished to determine whether a comprehensive, regional, hospital-based, parent education program, administered at the time of the child's birth, could be successfully implemented and to examine its impact on the incidence of abusive head injuries among infants <36 months of age.Methods. All hospitals that provide maternity care in an 8-county region of western New York State participated in a comprehensive regional program of parent education about violent infant shaking. The program was administered to parents of all newborn infants before the infant's discharge from the hospital. The hospitals were asked to provide both parents (mothers and, whenever possible, fathers or father figures) with information describing the dangers of violent infant shaking and providing alternative responses to persistent infant crying and to have both parents sign voluntarily a commitment statement (CS) affirming their receipt and understanding of the materials. Program compliance was assessed by documenting the number of CSs signed by parents and returned by participating hospitals. Follow-up telephone interviews were conducted with a randomized 10% subset of parents, 7 months after the child's birth, to assess parents' recall of the information. Finally, the regional incidence of abusive head injuries among infants and children <36 months of age during the program (study group) was contrasted with the incidence during the 6 preceding years (historical control group) and with statewide incidence rates for the Commonwealth of Pennsylvania during the control and study periods, using Poisson regression analyses with a type I error rate of 0.05.Results. During the first 5. C affey 1,2 first used the term whiplash-shaken infant syndrome to describe the association of intracranial injuries, retinal hemorrhage, and certain long bone fractures attributable to child abuse among infants (the majority Ͻ1 year of age). Other terms for this condition include shaken baby syndrome or shaken infant syndrome, shaken impact syndrome, 3 infant shaken impact syndrome, 4 infant whiplash-shake injury syndrome, 5 abusive head trauma, 6 and inflicted, nonaccidental, or intentional head injury. Shaken infant syndrome is the most widely used and recognized term, although shaking alone may not account for all injuries. 3 Whatever the terminology and pathogenesis, abusive head injuries among infants represent one of the most severe forms of child abuse, with 13 to 30% mortality rates 4,5,7,8 and significant neurologic impairments in at least one half of the survivors. 9 The economic costs of abusive head injuries are significant; initial inpatient hospitalization costs average $18 000 to $70 000 per child, and average ongoing medical costs can exceed $300 000 per child. [10...

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Computed Tomography of Craniocerebral Injury in the Abused Child

Cited by 154 publications

References 10 publications

Cranial computed tomography in the abused child with head injury

Cranial computed tomography in the abused child with head injury

Serial neuroimaging in infants with abusive head trauma: timing abusive injuries

Preventing Abusive Head Trauma Among Infants and Young Children: A Hospital-Based, Parent Education Program

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