Subdural haemorrhages in infants: population based study

Jayawant, Sandeep; Rawlinson, Alana Resmini; Gibbon, Frances; Price, Jackie F.; Schulte, Joann; Sharples, Peta M.; Sibert, Jonathan Richard; Kemp, Alison

doi:10.1136/bmj.317.7172.1558

Cited by 278 publications

(177 citation statements)

References 16 publications

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“…[67][68][69][70] The prevalence of abuse in young children with head injury was also high, ranging from 14% to 70% depending on the age of the child, the type and severity of head injury and the measurement of physical abuse. [71][72][73][74][75][76] …”

Section: Review Resultsmentioning

confidence: 99%

Performance of screening tests for child physical abuse in accident and emergency departments

Woodman¹,

Pitt²,

Wentz³

et al. 2008

Health Technol Assess

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How to obtain copies of this and other HTA Programme reports. An electronic version of this publication, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable CD-ROM is also available (see below).Printed copies of HTA monographs cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our Despatch Agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. Contact details are as follows: Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase orderYou can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA Programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment ProgrammeT he Health Technology Assessment (HTA) Programme, part of the National Institute for HealthResearch (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA Programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service'. The HTA Programme is needs led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of projects. First is the commissioned route. Suggestions for research are actively sought from people working in t...

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Section: Review Resultsmentioning

confidence: 99%

Performance of screening tests for child physical abuse in accident and emergency departments

Woodman¹,

Pitt²,

Wentz³

et al. 2008

Health Technol Assess

View full text Add to dashboard Cite

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“…With estimated annual incidence of AHT of 12.8 to 17 per 100 000 children ,2 years old and 21 to 33.8 per 100 000 children ,1 year old, [11][12][13][14] many pediatricians may see only a handful of cases in their practice. Yet given the backlash physicians may face 15 and expectations that those testifying in the courts must be able to support their opinions with scientific evidence, 16,17 consolidating the scientific evidence into decisionmaking is paramount.…”

mentioning

confidence: 99%

Validation of a Prediction Tool for Abusive Head Trauma

et al. 2015

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BACKGROUND AND OBJECTIVES: Abusive head trauma (AHT) may be missed in the clinical setting. Clinical prediction tools are used to reduce variability in practice and inform decision-making. From a systematic review and individual patient data analysis we derived the Predicting Abusive Head Trauma (PredAHT) tool, using multilevel logistic regression to predict likelihood of AHT. This study aims to externally validate the PredAHT tool.METHODS: Consecutive children aged ,36 months admitted with an intracranial injury, confirmed as abusive or nonabusive, to 2 sites used in the original model were ascertained. Details of 6 influential features were recorded (retinal hemorrhage, rib and long -bone fractures, apnea, seizures, and head or neck bruising). We estimated the likelihood of an unrecorded feature being present with multiple imputation; analysis included sensitivity, specificity, and area under the curve, with 95% confidence intervals (CIs).RESULTS: Data included 133 non-AHT cases and 65 AHT cases, 97% of children were ,24 months old. Consistent with original predictions, when $3 features were present in a child ,36 months old with intracranial injury, the estimated probability of AHT was .81.5% (95% CI, 63.3-91.8). The sensitivity of the tool was 72.3% (95% CI, 60.4-81.7), the specificity was 85.7% (95% CI, 78.8-90.7), area under the curve 0.88 (95% CI, 0.823-0.926).CONCLUSIONS: When tested on novel data, the PredAHT tool performed well. This tool has the potential to contribute to decision-making in these challenging cases. An implementation study is needed to explore its performance and utility within the child protection process. WHAT'S KNOWN ON THIS SUBJECT:A previous multivariable statistical model, using individual patient data, estimated the probability of abusive head trauma based on the presence or absence of 6 clinical features: rib fracture, long-bone fracture, apnea, seizures, retinal hemorrhage, and head or neck bruising. WHAT THIS STUDY ADDS:The model performed well in this validation, with a sensitivity of 72.3%, specificity of 85.7%, and area under the curve of 0.88. In children ,3 years old with intracranial injury plus $3 features, the estimated probability of abuse is .81.5%. Ms Cowley drafted the Methods section, produced the tables, revised the article, formatted the article, and contributed to overall editing; Dr Morris collected the data in data set 1 and entered all anonymized data into the database; Dr. Maguire had the initial study idea, drafted and revised the article, and contributed to the study design and overall editing; Dr Farewell designed and conducted all statistical analyses, drafted the statistical components of the article, produced the figures, and contributed to overall editing; Prof Kemp revised the article and contributed to overall study design and editing; and all authors approved the final manuscript as submitted. Clinicians who undertake child protection investigations of children presenting with head injury can meet resistance and face a barrage of critici...

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13] Birthrelated trauma is used in the court of law as an explanation for SDH in infants with suspected NAI because a variety of hemorrhages have been reported in term neonates. A study of the appearance and natural evolution of these birth-related hemorrhages, particularly SDH, is important in the forensic evaluation of NAI.…”

mentioning

confidence: 99%

Prevalence and Evolution of Intracranial Hemorrhage in Asymptomatic Term Infants

Rooks¹,

Eaton²,

Ruess³

et al. 2008

AJNR Am J Neuroradiol

253

197

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BACKGROUND AND PURPOSE:Subdural hemorrhage (SDH) is often associated with infants experiencing nonaccidental injury (NAI). A study of the appearance and natural evolution of these birth-related hemorrhages, particularly SDH, is important in the forensic evaluation of NAI. The purpose of this study was to determine the normal incidence, size, distribution, and natural history of SDH in asymptomatic term neonates as detected by sonography (US) and MR imaging within 72 hours of birth.

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Subdural haemorrhages in infants: population based study

Cited by 278 publications

References 16 publications

Performance of screening tests for child physical abuse in accident and emergency departments

Performance of screening tests for child physical abuse in accident and emergency departments

Validation of a Prediction Tool for Abusive Head Trauma

Prevalence and Evolution of Intracranial Hemorrhage in Asymptomatic Term Infants

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