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Pattern of subdural haemorrhages

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.


Interhemispheric haemorrhages

Meta-analysis of seven studies 1-7 showed that interhemispheric haemorrhages were significantly associated with abusive head trauma (AHT), with an odds ratio (OR) of 8.03 (95% confidence interval 5.58 – 11.56, I2=0%; p<0.00001)


Multiple subdural haemorrhages

There were only two studies 1,2 that looked at children with multiple extra-axial haemorrhages, both demonstrating a strong association with AHT and an overall OR of 6.01 (95% confidence interval 2.52 – 14.35, I2=0%; p<0.0001) 


Subdural haemorrhage (SDH) over the convexities

Meta-analysis of three studies 1,2,7 gave an overall OR for convexity SDH and AHT of 4.93 (95% confidence interval 1.25 – 19.42, I2=75%; p=0.02) 


Infra-tentorial / posterior fossa haemorrhages

Infra-tentorial / posterior fossa haemorrhages were associated with AHT; meta-analysis of three studies 1,2,4 gave an overall OR for AHT of 2.55 (95% confidence interval 1.06 – 6.13, I2=0%; p=0.047) 


Bilateral haemorrhages

A meta-analysis of four studies 2,5,6,8 showed that bilateral subdurals are significantly associated with AHT (OR 3.36, 95% confidence interval 1.10 – 10.27, I2=77%; p=0.03)


Attenuation of extra-axial haemorrhages on the initial computerised tomography (CT) scan

Despite the fact that different studies used different terminology, five studies 1,6,7,9,10 concluded that multiple SDH of different attenuations were reported on initial CT, predominantly in AHT

Low attenuation haemorrhages were more commonly seen in AHT than in non-abusive head trauma (nAHT) 2,4,6,7,9,10

Mixed attenuation – two studies reported SDH of mixed attenuation (different attenuation in the same SDH):

  • Tung et al 11 stated they were seen significantly more often in AHT than in nAHT
  • Vinchon (2004) 12 noted that they were equally prevalent in both conditions


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  1. Datta S, Stoodley N, Jayawant S, Renowden S, Kemp A. Neuroradiological aspects of subdural haemorrhages. Archives of Disease in Childhood. 2005;90(9):947-951 [Pubmed]
  2. Ewing-Cobbs L, Prasad M, Kramer L, Louis PT, Baumgartner J, Fletcher JM, Alpert B. Acute neuroradiologic findings in young children with inflicted or noninflicted traumatic brain injury. Child's Nervous System. 2000;16(1):25-33, discussion 34 [Pubmed]
  3. Goldstein B, Kelly MM, Bruton D, Cox C. Inflicted versus accidental head injury in critically injured children. Critical Care Medicine. 1993;21(9):1328-1332 [Pubmed]
  4. Hymel KP, Rumack CM, Hay TC, Strain JD, Jenny C. Comparison of intracranial computed tomographic (CT) findings in pediatric abusive and accidental head trauma. Pediatric Radiology. 1997;27(9):743-747 [Pubmed]
  5. 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]

  6. Kelly P, Hayes I. Infantile subdural haematoma in Auckland, New Zealand: 1988-1998. New Zealand Medical Journal. 2004;117(1201):U1047 [Pubmed]
  7. Wells RG, Vetter C, Laud P. Intracranial hemorrhage in children younger than 3 years: prediction of intent. Archives of Pediatrics and Adolescent Medicine. 2002;156(3):252-257 [Pubmed]
  8. 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]
  9. Feldman KW, Bethel R, Shugerman RP, Grossman DC, Grady MS, Ellenbogen RG. The cause of infant and toddler subdural hemorrhage: a prospective study. Pediatrics. 2001;108(3):636-646 [Pubmed]
  10. Adamo MA, Drazin D, Smith C, Waldman JB. Comparison of accidental and nonaccidental traumatic brain injuries in infants and toddlers: demographics, neurosurgical interventions, and outcomes. Journal of Neurosurgery: Pediatrics. 2009;4(5):414-419 [Pubmed]
  11. Tung GA, Kumar M, Richardson RC, Jenny C, Brown WD. Comparison of accidental and nonaccidental traumatic head injury in children on noncontrast computed tomography. Pediatrics. 2006;118(2):626-633 [Pubmed]
  12. Vinchon M, Noulé N, Tchofo PJ, Soto-Ares G, Fourier C, Dhellemmes P. Imaging of head injuries in infants: temporal correlates and forensic implications for the diagnosis of child abuse. Journal of Neurosurgery. 2004;101(1 Suppl):44-52 [Pubmed]


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