Neuroimaging, Physical, and Developmental Findings After Inflicted and Noninflicted Traumatic Brain Injury in Young Children

Ewing‐Cobbs, Linda; Kramer, Larry A.; Prasad, Mary R.; Canales, Denise Niles; Louis, Penelope T.; Fletcher, Jack Μ.; Vollero, Hilda; Landry, Susan H.; Cheung, Kim K

doi:10.1542/peds.102.2.300

Cited by 320 publications

(195 citation statements)

References 31 publications

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“…Child abuse injuries, particularly traumatic brain injuries, may result in significant long-term disabilities including learning deficits, attention-deficit/hyperactivity disorder, behavioral problems, seizures, spasticity, blindness, paralysis, and mental retardation. 23,24 Continuity of care for such children is essential, especially if they are transferred to other caregivers or foster homes.…”

Section: Role Of the Pediatricianmentioning

confidence: 99%

Evaluation of Suspected Child Physical Abuse

Kellogg¹

2007

Pediatrics

250

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This report provides guidance in the clinical approach to the evaluation of suspected physical abuse in children. The medical assessment is outlined with respect to obtaining a history, physical examination, and appropriate ancillary testing. The role of the physician may encompass reporting suspected abuse; assessing the consistency of the explanation, the child's developmental capabilities, and the characteristics of the injury or injuries; and coordination with other professionals to provide immediate and long-term treatment and follow-up for victims. Accurate and timely diagnosis of children who are suspected victims of abuse can ensure appropriate evaluation, investigation, and outcomes for these children and their families. PREVALENCEIn 2004, 152 250 children and adolescents were confirmed victims of physical abuse in the United States. 1 Of the 4 types of child maltreatment (neglect, physical abuse, sexual abuse, and emotional abuse), physical abuse is second to neglect, constituting approximately 18% of the total. 1 Despite these statistics, the estimated number of victims is much higher; in 1 retrospective cohort study of 8613 adults, 26.4% reported they were pushed, grabbed, or slapped; had something thrown at them; or were hit so hard they got marks or bruises at some time during their childhood. 2 It has been estimated that 1.3% to 15% of childhood injuries that result in emergency department visits are caused by abuse. 3 Physical abuse remains an underreported (and often undetected) problem for several reasons including individual and community variations in what is considered "abuse," inadequate knowledge and training among professionals in the recognition of abusive injuries, unwillingness to report suspected abuse, and professional bias. For example, in 1 study, 4 31% of children and infants with abusive head trauma were initially misdiagnosed. Misdiagnosed victims were more likely to be younger, white, have less severe symptoms, and live with both parents when compared with abused children who were not initially misdiagnosed. Such studies suggest a need for practitioners to be vigilant to the possibility of abuse when evaluating children who have atypical accidental injuries or obscure symptoms that are suggestive of traumatic etiologies but who do not have a history of trauma.Child abuse has significant long-term medical and mental health morbidity. 5 Children with abusive head or abdominal injuries are more likely to die or become more severely incapacitated than are children with head or abdominal injuries caused by accidents. 6-8 Victims of physical abuse in childhood are more likely to www.pediatrics.org/cgi

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Section: Role Of the Pediatricianmentioning

confidence: 99%

Evaluation of Suspected Child Physical Abuse

Kellogg¹

2007

Pediatrics

250

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“…5,11,28,29 The majority of serious traumatic brain injuries in infants and toddlers is due to child abuse, and abused children with brain injury have a worse outcome than children who sustain an accidental brain injury. 5,13 The actual mechanism of injury responsible for subdural hemorrhage, retinal hemorrhage, axonal injury, and skeletal trauma that characterize abusive head injury has been debated for decades. Caffey 6,7 first proposed the term "whiplash shaken infant syndrome" to describe the occurrence of subdural and retinal hemorrhages in response to presumed inflicted angular acceleration of the head.…”

mentioning

confidence: 99%

Anthropomorphic simulations of falls, shakes, and inflicted impacts in infants

Prange

Coats²,

Duhaime³

et al. 2003

Journal of Neurosurgery

164

117

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Object. Rotational loading conditions have been shown to produce subdural hemorrhage and diffuse axonal injury. No experimental data are available with which to compare the rotational response of the head of an infant during accidental and inflicted head injuries. The authors sought to compare rotational deceleration sustained by the head among free falls, from different heights onto different surfaces, with those sustained during shaking and inflicted impact. Methods. An anthropomorphic surrogate of a 1.5-month-old human infant was constructed and used to simulate falls from 0.3 m (1 ft), 0.9 m (3 ft), and 1.5 m (5 ft), as well as vigorous shaking and inflicted head impact. During falls, the surrogate experienced occipital contact against a concrete surface, carpet pad, or foam mattress. For shakes, investigators repeatedly shook the surrogate in an anteroposterior plane; inflicted impact was defined as the terminal portion of a vigorous shake, in which the surrogate's occiput made contact with a rigid or padded surface. Rotational velocity was recorded directly and the maximum (peak—peak) change in angular velocity and the peak angular acceleration were calculated. Analysis of variance revealed significant increases in the and associated with falls onto harder surfaces and from higher heights. During inflicted impacts against rigid surfaces, the and were significantly greater than those measured under all other conditions. Conclusions. Vigorous shakes of this infant model produced rotational responses similar to those resulting from minor falls, but inflicted impacts produced responses that were significantly higher than even a 1.5-m fall onto concrete. Because larger accelerations are associated with an increasing likelihood of injury, the findings indicate that inflicted impacts against hard surfaces are more likely to be associated with inertial brain injuries than falls from a height less than 1.5 m or from shaking.

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“…For all three serum biomarkers, time to peak levels were also higher in the iTBI group. This study would suggest that children with iTBI are at increased risk for a poorer outcome and therefore requires more extensive rehabilitation [51][52][53]. A possible explanation is that children with iTBI have brain injuries that are delayed in diagnosis and treatment.…”

Section: Biomarkers In Inflicted Head Trauma (Itbi)mentioning

confidence: 86%

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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Neuroimaging, Physical, and Developmental Findings After Inflicted and Noninflicted Traumatic Brain Injury in Young Children

Abstract: Characteristic features of inflicted TBI included acute computed tomography/magnetic resonance imaging findings of preexisting brain injury, extraaxial hemorrhages, seizures, retinal hemorrhages, and significantly impaired cognitive function without prolonged impairment of consciousness.

Cited by 320 publications

References 31 publications

Evaluation of Suspected Child Physical Abuse

Evaluation of Suspected Child Physical Abuse

Anthropomorphic simulations of falls, shakes, and inflicted impacts in infants

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

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