Evaluation of Infants With Subdural Hematoma Who Lack External Evidence of Abuse

Morris, Mark W.; Smith, Sally S.; Cressman, Joanne; Ancheta, Joey

doi:10.1542/peds.105.3.549

Cited by 72 publications

(25 citation statements)

References 15 publications

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“…6,7 Proper diagnosis of mild AHT is difficult because caretakers rarely provide an accurate history, 8 infants present with nonspecific symptoms, such as vomiting or fussiness, and physical examination is often normal. [9][10][11] As a result, misdiagnosis is common and can have catastrophic medical consequences. [11][12][13] In a landmark study, 12 31% (54/173) of children diagnosed with AHT were evaluated previously by a physician for symptoms compatible with brain injury.…”

mentioning

confidence: 99%

Validation of the Pittsburgh Infant Brain Injury Score for Abusive Head Trauma

Berger

Fromkin²,

Herman

et al. 2016

Pediatrics

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BACKGROUND: Abusive head trauma is the leading cause of death from physical abuse. Misdiagnosis of abusive head trauma as well as other types of brain abnormalities in infants is common and contributes to increased morbidity and mortality. We previously derived the Pittsburgh Infant Brain Injury Score (PIBIS), a clinical prediction rule to assist physicians deciding which high-risk infants should undergo computed tomography of the head.

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mentioning

confidence: 99%

Validation of the Pittsburgh Infant Brain Injury Score for Abusive Head Trauma

Berger

Fromkin²,

Herman

et al. 2016

Pediatrics

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“…Proper diagnosis of ITBI is often difficult even for experienced, astute physicians because caretakers rarely provide a history of trauma (4,5), children present with nonspecific symptoms, such as vomiting or fussiness (6) and physical examination can be normal (7,8). As a result, misdiagnosis is common and can have catastrophic medical consequences (9,10).…”

mentioning

confidence: 99%

Multiplex Assessment of Serum Biomarker Concentrations in Well-Appearing Children With Inflicted Traumatic Brain Injury

et al. 2009

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Proper diagnosis of mild inflicted traumatic brain injury (ITBI) is difficult; children often present without a history of trauma and with nonspecific symptoms, such as vomiting. Previous studies suggest that biomarkers may be able to screen for brain injury in this population, but these studies focused on only a few biomarkers. We hypothesized that using multiplex bead technology we would be able to identify multiple differences in the serum biomarker profile between in children with ITBI and those without brain injury. We compared the concentrations of 44 serum biomarkers in 16 infants with mild ITBI and 20 infants without brain injury. There were significant group differences in the concentrations of nine of the 44 markers. Vascular cellular adhesion molecule (VCAM) (p Ͻ 0.00) and IL-6 (IL-6) (p Ͻ 0.00) had the most significant group differences; IL-6 was higher after ITBI, whereas VCAM was lower. Using VCAM and IL-6 in classification algorithms, we could discriminate the groups with a sensitivity and specificity of 87% and 90%, respectively. The results suggest significant changes in the serum biomarker profile after mild ITBI. Future research is needed to determine whether these biomarkers can screen for brain injury in infants with nonspecific symptoms. Proper diagnosis of ITBI is often difficult even for experienced, astute physicians because caretakers rarely provide a history of trauma (4,5), children present with nonspecific symptoms, such as vomiting or fussiness (6) and physical examination can be normal (7,8). As a result, misdiagnosis is common and can have catastrophic medical consequences (9,10). The importance of timely diagnosis of ITBI cannot be overemphasized: if not recognized, child abuse is an escalating form of trauma that often ends in death or disability (11).The frequency with which ITBI is misdiagnosed and the resulting morbidity and mortality are compounded by the lack of a well-established screening test to help physicians identify children who might benefit from evaluation with cranial computed tomography (CT). We previously reported on the possible use of serum biomarkers as screening tools for infants at increased risk of missed ITBI-infants without a history of trauma and with nonspecific symptoms (12-15). We focused on three well-established and relatively brain-specific markers: neuron-specific enolase, S100B, and myelin-basic protein.Our study evaluating these markers as screening tools for ITBI in high-risk infants showed that a combination of neuronspecific enolase and myelin-basic protein was 79% sensitive and 70% specific for brain injury (14). Contrary to previous literature in adults and older children, S100B was not specific for brain injury in infants.Biomarker concentrations in our previous studies have been measured using ELISA. ELISA allows for measurement of only one biomarker at a time and requires up to 100 L of serum for each biomarker. In young children, it is difficult to collect large sample volumes and 100 L may be the entire sample.Multiplex bead...

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“…Pada anak yang lebih muda, kecenderungan perdarahan subdural terjadi akibat tulang tengkorak yang masih elastis sehingga adanya akselerasi dan deselerasi pada regio oksipital dan fisura interhemisfer posterior menyebabkan perdarahan karena di regio tersebut sutura lambdoidea dan sutura sagitalis bertumpang tindih, akibatnya pergerakan tulang dapat menyebabkan robekan dari sinus duramater. 6,11 Kami menemukan kadar Hb<7 g/dL, pemanjangan apTT, GCS<8 dan penurunan refleks cahaya merupakan parameter yang dapat memprediksi mortalitas. Penelitian sebelumnya melaporkan bahwa adanya gangguan perdarahan akan sangat memengaruhi mortalitas, dengan angka kematian subyek dengan gangguan perdarahan hingga 41%.…”

Section: Pembahasanunclassified

Ketepatan Parameter Klinis dalam Memprediksi Mortalitas Perdarahan Intrakranial Spontan pada Anak Usia Kurang dari Satu Tahun

Sugono

Dewi

Bahar

2016

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Latar belakang. Pada anak usia di bawah satu tahun, perdarahan intrakranial memiliki tingkat mortalitas yang tinggi. Diperlukan parameter untuk memprediksi mortalitas guna menentukan tata laksana segera yang tepat sehingga diperoleh hasil akhir yang lebih baik. Tujuan. Mendapatkan tingkat akurasi parameter klinis dalam memprediksi mortalitas perdarahan intrakranial spontan pada anak dengan usia kurang dari satu tahun.

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Evaluation of Infants With Subdural Hematoma Who Lack External Evidence of Abuse

Cited by 72 publications

References 15 publications

Validation of the Pittsburgh Infant Brain Injury Score for Abusive Head Trauma

Validation of the Pittsburgh Infant Brain Injury Score for Abusive Head Trauma

Multiplex Assessment of Serum Biomarker Concentrations in Well-Appearing Children With Inflicted Traumatic Brain Injury

Ketepatan Parameter Klinis dalam Memprediksi Mortalitas Perdarahan Intrakranial Spontan pada Anak Usia Kurang dari Satu Tahun

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