Neuroimaging: what neuroradiological features distinguish abusive from non-abusive head trauma? A systematic review

• Published in: Archives of disease in childhood Vol. 96; no. 12; pp. 1103 - 1112
• Main Authors: Kemp, A M, Jaspan, T, Griffiths, J, Stoodley, N, Mann, M K, Tempest, V, Maguire, S A
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01.12.2011; BMJ Publishing Group; BMJ Publishing Group Ltd; BMJ Publishing Group LTD
• Subjects: Biological and medical sciences; Brain Edema - diagnosis; Brain Edema - etiology; Child; Child Abuse; Child abuse & neglect; Child Abuse - diagnosis; Child Neglect; Child Safety; Child, Preschool; Children & youth; Comparative Analysis; Comparative studies; Craniocerebral Trauma - etiology; Diagnosis, Differential; Diagnostic Tests; Edema; Evidence; Evidence-Based Medicine - methods; General aspects; Head injuries; Health aspects; Hemorrhage; Humans; Hypoxia; Infant; Infant, Newborn; Information Seeking; Injuries of the nervous system and the skull. Diseases due to physical agents; Intracranial Hemorrhages - diagnosis; Intracranial Hemorrhages - etiology; Ischemia; Magnetic Resonance Imaging; Medical imaging; Medical sciences; Meta Analysis; Miscellaneous; Neuroimaging; Neurology; Ophthalmology; Prevention and actions; Psychic trauma; Public health. Hygiene; Public health. Hygiene-occupational medicine; Search Strategies; Systematic review; Tomography, X-Ray Computed; Trauma; Trauma (Psychology); Traumas. Diseases due to physical agents; Young Children; Human; Pediatrics; Nervous system diseases; Craniocerebral; Medical imagery; Systematic review; Nervous system; Head trauma; Child; Public health
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2011-300630

Objectives To identify the evidence base behind the neuroradiological features that differentiate abusive head trauma (AHT) from non-abusive head trauma (nAHT). Design Systematic review. Setting Literature search of 14 databases, websites, textbooks, conference abstracts and references (1970–February 2010). Studies had two independent reviews (three if disputed) and critical appraisal. Patients Primary comparative studies of children <11 years old hospitalised with AHT and nAHT diagnosed on CT or MRI. Main outcome measures Neuroradiological features that differentiated AHT from nAHT. Results 21 studies of children predominantly <3 years old were analysed. Subdural haemorrhages (SDH) were significantly associated with AHT (OR 8.2, 95% CI 6.1 to 11). Subarachnoid haemorrhages were seen equally in AHT and nAHT and extradural haemorrhages (EDH) were significantly associated with nAHT (OR for AHT 0.1, 95% CI 0.07 to 0.18). Multiple (OR 6, 95% CI 2.5 to 14.4), interhemispheric (OR 7.9, 95% CI 4.7 to 13), convexity (OR 4.9, 95% CI 1.3 to 19.4) and posterior fossa haemorrhages (OR 2.5, 95% CI 1 to 6) were associated with AHT. Hypoxic-ischaemic injury (HII) (OR 3.7, 95% CI 1.4 to 10) and cerebral oedema (OR 2.2, 95% CI 1.0 to 4.5) were significantly associated with AHT, while focal parenchymal injury was not a discriminatory feature. SDH of low attenuation were more common in AHT than in nAHT. Conclusion Multiple SDH over the convexity, interhemispheric haemorrhages, posterior fossa SDH, HII and cerebral oedema are significantly associated with AHT and should be considered together with clinical features when identifying the condition.