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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.


  • Of 374 studies reviewed from the international literature, 16 articles addressed this issue 1-16
  • Study design:
    • 2 case-control
    • 8 cross-sectional
    • 1 longitudinal cohort
    • 5 case series
  • Total data:
    • 1945 children
    • 917 with abusive head trauma (AHT)
    • 1028 with non-abusive head trauma (nAHT)


  • Less than three years in 13 studies 1,2,4-6,8-11,13-16
  • 0-16 years in three studies 3,7,12
  • Children with AHT were younger than those with nAHT 4,9,10,15



  • Boys sustained more intracranial injuries than girls but there was no difference between AHT and nAHT 1-7,10,14,15


Influence of ethnicity and socio-economic group

  • Three studies addressed ethnicity and found no significant difference between groups 1-3
  • AHT was found to be more common in the lower socio-economic groups, in two out of the three studies addressing this issue 2,3,5


No study addressed the diagnosis of AHT in disabled children


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  1. Bechtel K, Stoessel K, Leventhal JM, Ogle E, Teague B, Lavietes S, Banyas B, Allen K, Dziura J, Duncan C. Characteristics that distinguish accidental from abusive injury in hospitalized young children with head trauma. Pediatrics. 2004;114(1):165-168 [Pubmed]
  2. Ettaro L, Berger RP, Songer T. Abusive head trauma in young children: characteristics and medical charges in a hospitalized population. Child Abuse and Neglect. 2004;28(10):1099-1111 [Pubmed]
  3. Ewing-Cobbs L, Kramer L, Prasad M, Canales DN, Louis PT, Fletcher JM, Vollero H, Landry SH, Cheung K. Neuroimaging, physical, and developmental findings after inflicted and noninflicted traumatic brain injury in young children. Pediatrics 1998;102(2 Pt 1):300-307 [Pubmed]
  4. Fung EL, Sung RY, Nelson EA, Poon WS. Unexplained subdural hematoma in young children: is it always child abuse? Pediatrics International 2002;44(1):37-42 [Pubmed]
  5. Hettler J, Greenes DS. Can the initial history predict whether a child with a head injury has been abused? Pediatrics 2003;111(3):602-607 [Pubmed]
  6. Hobbs C, Childs AM, Wynne J, Livingston J, Seal A. Subdural haematoma and effusion in infancy: an epidemiological study. Archives of Disease in Childhood. 2005;90(9):952-955 [Pubmed]
  7. Hoskote A, Richards P, Anslow P, McShane T. Subdural haematoma and non-accidental head injury in children. Child's Nervous System. 2002;18(6-7):311-317 [Pubmed]
  8. Hymel KP, Willson DF, Boos SC, Pullin DA, Homa K, Lorenz DJ, Herman BE, Graf JM, Isaac R, Armijo-Garcia V, Narang SK, Pediatric Brain Injury Research Network (PediBIRN) Investigators. Derivation of a clinical prediction rule for pediatric abusive head trauma. Pediatric Critical Care Medicine. 2013;14(2):210-220. [Pubmed]

  9. 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]
  10. Kemp AM, Stoodley N, Cobley C, Coles L, Kemp KW. Apnoea and brain swelling in non-accidental head injury. Archives of Disease in Childhood. 2003;88(6):472-476, discussion 476 [Pubmed]
  11. Pierre-Kahn V, Roche O, Dureau P, Uteza Y, Renier D, Pierre-Kahn A, Dufier JL. Ophthalmologic findings in suspected child abuse victims with subdural hematomas. Ophthalmology. 2003;110(9):1718-1723 [Pubmed]
  12. Ruppel RA, Kochanek PM, Adelson PD, Rose ME, Wisniewski SR, Bell MJ, Clark RS, Marion DW, Graham SH. Excitatory amino acid concentrations in ventricular cerebrospinal fluid after severe traumatic brain injury in infants and children: the role of child abuse. Journal of Pediatrics 2001;138(1):18-25 [Pubmed]
  13. Shugerman RP, Paez A, Grossman DC, Feldman KW, Grady MS. Epidural hemorrhage: is it abuse? Pediatrics. 1996;97(5):664-648 [Pubmed]
  14. Thalayasingam M, Veerakumarasivam A, Kulanthayan S, Khairuddin F, Cheah IGS. Clinical clues for head injuries amongst Malaysian infants: Accidental or non-accidental? Injury, International Journal of the Care of the Injured. 2012;43:2083-2087. [Pubmed]

  15. Tzioumi D, Oates RK. Subdural hematomas in children under 2 years. Accidental or inflicted? A 10-year experience. Child Abuse and Neglect. 1998;22(11):1105-1112 [Pubmed]
  16. Vinchon M, Defoort-Dhellemmes S, Desurmont M, Dhellemmes P. Accidental and nonaccidental head injuries in infants: a prospective study. Journal of Neurosurgery. 2005;102(4 Suppl):380-384 [Pubmed]


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