Intracranial Hemorrhage in Children Younger Than 3 Years

Wells, Robert G.; Vetter, Christine; Laud, Prakash

doi:10.1001/archpedi.156.3.252

Cited by 50 publications

(30 citation statements)

References 14 publications

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“…Articles were included if they indicated the frequency of males and females with TBII and were classified into 3 TBII groups: Group 1-neonatal SDH from birth trauma 5,16 -21 Group 2-SDH in young infants from accidental falls [21][22][23][24][25][26][27][28][29][30][31][32] Group 3-SDH from nonaccidental TBII (SBS). 21,22,[27][28][29][30][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] The same type of literature search was also done to determine if there are any gender differences in macrocephaly related to IEAFS (also called external hydrocephalus, benign subdural collections of infancy, benign subdural hygromas, and other terms) which is group 4. If there was no association of gender with TBII or with macrocephaly, then the expected percentage of males would be about 51.4% which is the percentage of births that are male in North America and Europe over the second half of the 20th century.…”

Section: Methodsmentioning

confidence: 99%

Overrepresentation of Males in Traumatic Brain Injury of Infancy and in Infants With Macrocephaly

Miller

2010

American Journal of Forensic Medicine &Amp; Pathology

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Shaken baby syndrome (SBS) has been thought to be caused by violent shaking of an infant and is characterized by the triad of findings: subdural hematoma (SDH), retinal hemorrhages, and neurologic abnormalities. The triad is not specific for SBS and can be seen in accidental trauma and in certain medical conditions. Recent observations, however, question whether SBS exists. Herein, we review the gender differences in 3 groups of infants with traumatic brain injury: (1) neonates with SDH from birth trauma, (2) infants with SDH from accidental trauma, and (3) infants with SDH from SBS. Gender differences are also presented in a fourth group of infants with macrocephaly related to increased extra-axial fluid spaces (IEAFS). Compared with the expected male frequency of 51.4% in newborns, there was a statistically significant overrepresentation of males in each of the 4 groups-65.3%, 62.2%, 62.6%, and 68.8%, respectively. We believe that the most likely explanation for these findings relates to the larger head size of the male compared with the female which has several relevant consequences. First, the larger head circumference of a male newborn compared with a female newborn may increase the likelihood that a male newborn will incur a small SDH from the minor trauma of the birthing process that can later rebleed and present with a symptomatic SDH that could be misdiagnosed as SBS and child abuse. Second, a short fall would have a greater likelihood of causing a SDH in a male infant than a female infant who could subsequently become symptomatic from hours to weeks later and could thus present as an unexplained SDH. Third, infants with macrocephaly related to IEAFS may be at increased risk for developing a SDH from the larger head size and greater tautness of the bridging vessels in the extra-axial fluid spaces. We believe that many infants who have been diagnosed with SBS have been given incorrect diagnoses of child abuse. Rather, their SDH may occur as a result of a small SDH from the birthing process that enlarges during early infancy, a short fall, or from macrocephaly with IEAFS.

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Section: Methodsmentioning

confidence: 99%

Overrepresentation of Males in Traumatic Brain Injury of Infancy and in Infants With Macrocephaly

Miller

2010

American Journal of Forensic Medicine &Amp; Pathology

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“…The appearances of a SDH in the acute setting can range from homogenous hyper-, hypo-or mixed density, in patterns which may be laminated, layered or sedimented. Low or mixed density subdural collections may develop within the first 24 hours after head injury (Wells et al 2002;Vinchon et al 2003Vinchon et al , 2004Wells and Sty 2003;Zouros et al 2004). The acute low density fluid in isolation or in association with acute SDH may be because actively bleeding unclotted blood (hypodense) is mixing with clotted hyperdense blood, or because there is Widened subdural spaces (particularly in the frontal region) and a small persistent high signal of a posterior fossa subdural are seen.…”

Section: Subdural Haemorrhage and Brain Injuriesmentioning

confidence: 99%

Non‐Sexual Abuse in Children

Minns¹,

Madea²,

Kernbach-Wighton³

2014

Handbook of Forensic Medicine

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“…The authors deemed all studies identified to have some methodological or quality issues as defined by a priori criteria. Four studies were specific to head injury, while three evaluated general abusive injuries [11][12][13][14][15][16][17]. The studies looked at a variety of predictive factors for child abuse including individual criteria such as severe retinal hemorrhage, brain ischemia, presence of subdural hematoma, lack of history or low-impact trauma history, imaging patterns, bruise location consistent with fracture site, as well as tools integrating multiple factors such as a combination of bruise region, age of child, and mechanism history or a combination of age of child, physical exam findings, and imaging results.…”

Section: Detection Of Child Abusementioning

confidence: 99%

Hallmarks of Non-accidental Trauma: A Surgeon’s Perspective

Garcia

Lawson

2014

Curr Surg Rep

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Child abuse is a public health epidemic in the United States with high incidence, prevalence, and severe personal and societal impact. Surgeons should be considering child abuse in their treatment of children with traumatic injury. Screening for child abuse mechanism in the ED and in-patient settings is not precise, subject to bias and often incomplete. A variety of tools and factors have been studied for their predictive potential despite inherent methodological issues; thus, no one screening tool has been proposed as the standard of care. More research is warranted to better define how to best screen patients for the need for further child abuse investigation. Given the accumulative impact of ionizing radiation with children, the utilization of unnecessary CTs should be limited. For instance, the use of head CT in children suspected of inflicted head trauma should be limited; however, very few additional screening modalities exist to better identify the subset of children that need a CT. Studies on serum CSF biomarkers of head injury are promising and yet require further research in order to recommend their use in the clinical setting.

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Intracranial Hemorrhage in Children Younger Than 3 Years

Abstract: Computed tomographic imaging patterns of intracranial hemorrhage in children younger than 3 years help predict whether the injury was intentional.

Cited by 50 publications

References 14 publications

Overrepresentation of Males in Traumatic Brain Injury of Infancy and in Infants With Macrocephaly

Overrepresentation of Males in Traumatic Brain Injury of Infancy and in Infants With Macrocephaly

Non‐Sexual Abuse in Children

Hallmarks of Non-accidental Trauma: A Surgeon’s Perspective

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