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Neurological Injuries

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.

 

Review last updated in August 2014

Abusive head trauma (AHT) is the term the American Academy of Pediatrics 1 recommends that paediatricians use when describing an inflicted injury to the head and its contents. AHT remains the commonest form of fatal child abuse and predominantly affects infants.2  While there has been a large body of literature relating to spinal injuries, no new studies have been included addressing the neuroradiological or clinical features of abusive head trauma within the past year. One study addressing the ability of neuroradiologists to date subdural haemorrhages has been included.3

 

It is well recognised that a number of children with AHT may have this diagnosis missed when they first come into contact with child health practitioners.4

 

Current controversies exist around clinicians’ ability to confidently diagnose AHT; we hope this review highlights the strength of evidence that one can rely on in this regard.

 

New high quality studies have also enabled us to update the original meta-analysis of the Neuroradiological features that distinguish abusive from non-abusive head trauma

 

The review seeks to answer the following review questions:

  1. What neuroradiological investigations are indicated to identify abusive central neurological system injury in children?
  2. What are the distinguishing clinical features of abusive head trauma in children?
  3. What neuroradiological features distinguish abusive from non-abusive head trauma?
  4. Can you date inflicted intracranial injuries in children neuroradiologically?

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References

  1. Christian CW, Block R, Committee on Child Abuse and Neglect, American Academy of Pediatrics. Policy statement: abusive head trauma in infants and children. 2009;123(5):1409-1411 [Pubmed]
  2. Keenan HT, Runyan DK, Marshall SW, Nocera MA, Merten DF. A population-based comparison of clinical and outcome characteristics of young children with serious inflicted and noninflicted traumatic brain injury. Pediatrics. 2004;114(3):633-639 [Pubmed]
  3. Postema FA, Sieswerda-Hoogendoorn T, Majoie CB, van Rijn RR. Age determination of subdural hematomas: survey among radiologists. Emergency Radiology. 2014:21(4):349-358 [Pubmed]

  4. Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC. Analysis of missed cases of abusive head trauma. Journal of American Medical Association. 1999;281(7):621-626 [Pubmed]

 

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