G143 Head trauma in under 2’s – accidental vs inflicted?

Abstract

BackgroundHead injury is a common presenting complaint to emergency departments and can generate clinical concern regarding non accidental injury (NAI) in young children. Clinicians are wary of exposing young children to unnecessary radiation but must balance this risk with their duty to protect the child and recognise abuse.ObjectiveTo review all radiological imaging for trauma related head injuries in under-2 year olds with the aim of establishing the incidence of non-accidental injury and identify associated features that may aid clinical decision making.DesignA single-centre retrospective note review was conducted over a 3 year period (01/01/12 – 01/01/2015) of children<2 years of age who presented to a tertiary paediatric hospital (RHSC, Glasgow) and received cranial imaging. Cases were identified using the PACS reporting system.Results75 cases were identified as trauma related neuroimaging over the study period and were subject to a detailed case note review. Median age was 39 weeks. There was a male predominance of 65%. All 75 patients underwent CT head as their primary mode of trauma imaging.Abnormal findings were reported in 79% with the most common finding being unilateral parietal skull fracture. 44% of those with positive findings on CT underwent a skeletal survey and 36% had ophthalmology review. 31% had a social work strategy meeting prior to discharge.17% of patients with positive findings on CT head were deemed to have sustained their injury secondary to abuse. None of these injuries were witnessed. Median age was 16 weeks. 70% of inflicted injuries had a complex skull fracture compared to 18% for those deemed accidental. 20% of the NAI group were previously known to social work compared to 3% in the accidental group.ConclusionCT is the modality of choice for suspected skull fracture in RHSC, Glasgow. Younger age, unwitnessed injury, existing social work support and complex skull fracture were all associated more commonly with abusive injuries in this 3 year review. Our data has contributed to a larger UK study aiming to determine national variation in practice and deriving a clinical decision making tool to exclude/diagnose NAI as the cause of skull fracture.