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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.


  • Study designs:
  • 20 cross-sectional 1-3,5-10,12-19,21,23,25
  • 2 case-controls 4,11
  • 2 comparative case series 20,24
  • 1 prospective cohort 22


  • Age:
    21/25 studies focused on age groups under three years of age 1-3,5,6,8,10,12-25
    Four studies included children aged up to four 11, five 4, six 7 and 16 9 years respectively 26 Table 2
  • Gender:

Of four studies addressing gender, three found no significant difference 1,4,22

One study showed more boys than girls in the abusive head trauma (AHT) group 19


  • Neuroimaging:
    All studies included an initial computerised tomography scan, many with additional magnetic resonance imaging (MRI), with the exception of Ichord et al13 which relied solely upon MRI


Influence of ethnicity and socio-economic group

One study addressed ethnicity and found no difference 19

There was no significant difference in socio-economic group in one Mexican study that explored this 4


Among the recent studies, one includes a detailed examination of a subset of the data from previous studies 22-24


*We would like to thank the authors of studies 12 and 22 for providing raw data to enable the meta-analyses

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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. 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]
  4. 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]

  5. 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]
  6. 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]
  7. 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]
  8. 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]
  9. 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]
  10. 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]
  11. 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]
  12. 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]

  13. Ichord RN, Naim M, Pollock AN, Nance ML, Margulies SS, Christian CW. Hypoxic-ischemic injury complicates inflicted and accidental traumatic brain injury in young children: the role of diffusion-weighted imaging. Journal of Neurotrauma. 2007;24(1):106-118. [Pubmed]
  14. 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]
  15. Kelly P, Hayes I. Infantile subdural haematoma in Auckland, New Zealand: 1988-1998. New Zealand Medical Journal. 2004;117(1201):U1047 [Pubmed]
  16. McKinney AM, Thompson LR, Truwitt CL, Velders S, Karagulle A, Kiragu A. Unilateral hypoxic-ischemic injury in young children from abusive head trauma, lacking craniocervical vascular dissection or cord injury. Pediatric Radiology. 2008;38(2):164-174 [Pubmed]
  17. Reece RM, Sege R. Childhood head injuries: accidental or inflicted? Archives of Pediatrics and Adolescent Medicine. 2000;154(1):11-15 [Pubmed]
  18. Shugerman RP, Paez A, Grossman DC, Feldman KW, Grady MS. Epidural hemorrhage: is it abuse? Pediatrics. 1996;97(5):664-648 [Pubmed]
  19. 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]

  20. 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]
  21. 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]
  22. 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]

  23. 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]
  24. 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]
  25. 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]
  26. Kemp AM, Jaspan T, Griffiths J, Stoodley N, Mann MK, Tempest V, Maguire SA. Neuroimaging: what neuroradiological features distinguish abusive from non-abusive head trauma? A systematic review. Archives of Disease in Childhood. 2011;96(12):1103-1112 [Pubmed]


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