Nonaccidental head injury in children

Al-Holou, Wajd N.; O'Hara, Edward A.; Cohen-Gadol, Aaron; Maher, Cormac O.

doi:10.3171/2009.1.peds08365

Cited by 11 publications

(10 citation statements)

References 54 publications

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“…Frustrated by that term, a prominent British neurosurgeon, Sir Wilfred Trotter, identified trauma as the primary etiology of subdural hemorrhages. 3 Trotter stated, '' [Subdural hemorrhages] [are] almost if not quite invariably a true traumatic haemorrhage coming from veins torn in their course between the brain and a dural sinus.'' 3 Trotter's work paved the way for other physicians to reexamine the pathophysiology of subdural hemorrhages.…”

Section: Historical Contextmentioning

confidence: 99%

Abusive Head Trauma

Narang

Clarke

2014

J Child Neurol

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Abusive head trauma has a robust and interesting scientific history. Recently, the American Academy of Pediatrics has endorsed a change in terminology to a term that is more general in describing the vast array of abusive mechanisms that can result in pediatric head injury. Simply defined, abusive head trauma is "child physical abuse that results in injury to the head or brain." Abusive head trauma is a relatively common cause of childhood neurotrauma, with an estimated incidence of 16 to 33 cases per 100,000 children per year in the first 2 years of life. Clinical findings are variable; AHT should be considered in all children with neurologic signs and symptoms, especially if no or only mild trauma is described. Subdural and retinal hemorrhages are the most common findings. The current best evidence-based literature has identified some features--apnea and severe retinal hemorrhages--that reliably discriminate abusive from accidental injury. Longitudinal studies of outcomes in abusive head trauma patients demonstrate that approximately one-third of the children are severely disabled, one third of them are moderately disabled, and one third have no or only mild symptoms. Abusive head trauma cases are complex cases that require a rigorous, multidisciplinary team approach. The clinician can establish this diagnosis with confidence if he/she maintains a high index of suspicion for the diagnosis, has knowledge of the signs, symptoms, and risk factors of abusive head trauma, and reasonably excludes other etiologies on the differential diagnosis.

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Section: Historical Contextmentioning

confidence: 99%

Abusive Head Trauma

Narang

Clarke

2014

J Child Neurol

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“…Aetiology of TBI varies with series reports on non-accidental causes in few selected studies,[ 13 14 15 16 ] but none was attributed to severe abuse and neglect.…”

Section: Discussionmentioning

confidence: 99%

Menace of childhood non-accidental traumatic brain injuries: A single unit report

Ibrahim¹,

Mu'azu²,

Idris³

et al. 2015

Afr J Paediatr Surg

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Background:Childhood traumatic brain injury (TBI) has high rate of mortality and morbidity worldwide. There are dearths of reports from developing countries with large paediatric population on trauma; neurosurgery trauma of nonaccidental origin is not an exemption. This study analysed menace of non-accidental TBI in the paediatric population from our center.Materials and Methods:This is a single unit, retrospective study of the epidemiology of non-accidental TBI in children starting from September, 2008 to March, 2014. The management outcomes of the epidemiology of the non-accidental TBI were analysed.Results:Total of 109 children age range from 0 (intra-natal) to 16 years with a mean of 5.8 ± 4.6 years (median, 5 years) were enrolled into the study. 34 (31.2%) were domestic violence, 26 (23.9%) street assaults, 16 (14.7%) were due to animal assaults and mishaps, 17 (15.6%) fall from heights. Seven (6.4%) cases of collapsed buildings were also seen during the period. Four (3.7%) industrial accidents and two (1.8%) were self-inflicted injuries. There were also three (2.8%) cases of iatrogenic TBI out of which two infants (1.8%) sustained TBI from cesarean section procedure while one patient (0.9%) under general anaesthesia felt from the operation bed resulting to severe TBI.Conclusion:Child abuse, unprotected child labour, parental/care-givers negligence are the main cause of nonaccidental TBI. Human right activists and government agents should be incorporated in curtailing the menace.

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“…RHs have been recognized as a key indicator of abusive head injury for more than 30 years. 15 Although mild and moderate RHs can be seen in a number of medical and traumatic conditions in children, 16 prospective and retrospective clinical studies have revealed that severe RH is strongly associated with AHT. 17,18 Approximately 25% of victims of AHT have no RH, and one-third of all cases have mild to moderate RH.…”

Section: Rhs and Ahtmentioning

confidence: 99%

The Eye Examination in the Evaluation of Child Abuse

Christian

Levin

Flaherty³

et al. 2018

Pediatrics

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Child abuse can cause injury to any part of the eye. The most common manifestations are retinal hemorrhages (RHs) in infants and young children with abusive head trauma (AHT). Although RHs are an important indicator of possible AHT, they are also found in other conditions. Distinguishing the number, type, location, and pattern of RHs is important in evaluating a differential diagnosis. Eye trauma can be seen in cases of physical abuse or AHT and may prompt referral for ophthalmologic assessment. Physicians have a responsibility to consider abuse in the differential diagnosis of pediatric eye trauma. Identification and documentation of inflicted ocular trauma requires a thorough examination by an ophthalmologist, including indirect ophthalmoscopy, most optimally through a dilated pupil, especially for the evaluation of possible RHs. An eye examination is helpful in detecting abnormalities that can help identify a medical or traumatic etiology for previously well young children who experience unexpected and unexplained mental status changes with no obvious cause, children with head trauma that results in significant intracranial hemorrhage and brain injury, and children with unexplained death.

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Nonaccidental head injury in children

Cited by 11 publications

References 54 publications

Abusive Head Trauma

Abusive Head Trauma

Menace of childhood non-accidental traumatic brain injuries: A single unit report

The Eye Examination in the Evaluation of Child Abuse

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