Traumatic Mechanisms of Head Injury in Child Abuse

Abstract

Child abuse is a complex sociophysical phenomenon in which a child may suffer physical and mental assault ranging from death to emotional deprivation. In this report, an effort is made to identify the pathogenetic mechanisms of head injury in child abuse and to describe the site of injury, incidence of head injury, and difficulties encountered in establishing a doctor-family relationship. During the years 1970 through 1979,621 children were confirmed victims of child abuse and treated by the medical staff at the Children’s Memorial Hospital in Chicago. Of these, there were 77 children (12%) who suffered associated head injuries ranging from cerebral concussion to irreversible brain damage and/or death. 85% of these head-injured children were under the age of 2 years. 62% were male and 38% female. In analyzing the type of injury which resulted in an associated head injury, we learned that 54% of all injuries were caused by direct blows to the head, face and other parts of the body, 35% were due to dropping, throwing or falling; only 8% were caused by ‘shaking’. 55 injuries (48%) out of 115 trauma cases were thought to be caused by injury to head or face. 53 patients showed 113 external skin wounds such as ecchymoses of eyes, excoriations, bruises, contusion, hematoma, burns, etc. 46% of all external wounds were found over the head and face. This may probably indicate to us that a traumatic force causing injury to the brain is directed to the head and face. The traumatic mechanisms are analyzed and discussed to assess the behavioral derangement of the assault.

Serial Radiography in the Infant Shaken Impact Syndrome

“…The present study likely includes most infants with ISIS treated in the region during this time (although it is possible that a few infants with minor injuries treated elsewhere, or infants with immediately fatal injuries, may have been excluded). The demographics of our study population, in terms of the gender of the infant, reported mechanism of injury, pattern of intracranial injury, and mortality rate, are similar to those of previous reports [15,18,25,33,34].…”

Epidemiologic characteristics and sequelae of closed head‐injured children and adolescents: A review

“…For example, Kraus, Fife, and Conroy (1987) noted that 23% of their subjects (n = 688) less than 14 years old had at least one fracture of the skull or facial bones. In addition, Hahn et al (1983) determined skull fractures, intracranial hematomas, cephalhematomas, and cerebral contusions occurred equally in their subjects. However, recovery has usually taken place quickly because damage in patients with depressed skull fractures is localized.…”

“…Some evidence has suggested contusions appear to be less common in pediatric HI than in adults (Shapiro, 1987). For example, Hahn, Raimondi, McLone, and Yamanouchi (1983) found only 23 out of 126 child-abused children with craniocerebral injuries suffered cerebral contusions. Yet, Heiskanen and Kaste (1974) noted 90% of their 37 CHI subjects who were less than 16 years old suffered diffuse cerebral contusions.…”

Acute neuroradiologic findings in young children with inflicted or noninflicted traumatic brain injury

“…Acute computed tomographic (CT) studies of children with inflicted head injury frequently identified the occurrence of interhemispheric or convexity subdural hematomas (SDH) [17,25,30,33,35,38], subarachnoid hemorrhage (SAH), cerebral edema [29,30,33,35,38], and skull fractures [3,8,11,17,19,30,31,35,38], and infrequently, of epidural hematomas [30,34]. Although the incidence of atrophy on acute CT was low, atrophy [35,38], subdural hygromas, and ventriculomegaly [30] were frequently found on scans obtained at least 20 days after admission or in chronic cases of abuse.…”