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Extra-axial 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.


 16 studies described details of extra-axial haemorrhages 1-16


Subdural haemorrhage (SDH)

  • 13 studies 1,2,4,5,7-15 compared the prevalence of SDH in abusive head trauma (AHT) and non-abusive head trauma (nAHT)
  • All studies confirmed that SDH was significantly associated with AHT.  Meta-analysis using a random effects model gave an overall odds ratio (OR) of 9.18 (95% confidence interval 7.12 – 11.83, I2 = 0%; p<0.00001) for SDH in AHT 


Subarachnoid haemorrhage (SAH)

  • 11 studies 1-3,6-8,10-12,14,16 described SAH which was equally prevalent in AHT and nAHT. The overall OR for AHT was 1.28 (95% confidence interval 0.67 – 2.44, I2 = 77%; p=0.95; p=0.45)


Extradural Haemorrhage (EDH)

  • 12 studies 1,2,4-8,10,11,13,14,16 confirmed a significant association between EDH and nAHT. The overall OR for EDH and AHT was 0.16 (95% confidence interval 0.10 – 0.25, I2 = 6%; p<0.00001)


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  1. 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]
  2. 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]
  3. Diaz-Olavarrieta C, Garcia-Pina CA, Loredo-Abdala A, Paz F, Garcia S.G, Schilmann A. Abusive head trauma at a tertiary care children's hospital in Mexico City. A preliminary study. Child Abuse & Neglect. 2011;35(11):915-923 [Pubmed]

  4. Duhaime AC, Alario AJ, Lewander WJ, Schut L, Sutton LN, Seidl TS, Nudelman S, Budenz D, Hertle R, Tsiaras W, Loporchio S. Head injury in very young children: mechanisms, injury types, and ophthalmologic findings in 100 hospitalized patients younger than 2 years of age. Pediatrics. 1992;90(2 Pt 1):179-185 [Pubmed]
  5. 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]
  6. 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]
  7. 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]
  8. 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]
  9. 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]
  10. 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]

  11. 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]
  12. Reece RM, Sege R. Childhood head injuries: accidental or inflicted? Archives of Pediatrics and Adolescent Medicine. 2000;154(1):11-15 [Pubmed]
  13. 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]

  14. Vinchon M, De Foort-Dhellemmes S, Desurmont M, Delestret I. Confessed abuse versus witnessed accidents in infants: comparison of clinical, radiological, and ophthalmological data in corroborated cases. Child's Nervous System. 2010;26(5):637-645. [Pubmed]

  15. 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]
  16. 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]


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