Neuroimaging Evaluation of Non-accidental Head Trauma with Correlation to Clinical Outcomes: A Review of 57 Cases

• Published in: The Journal of pediatrics Vol. 154; no. 4; pp. 573 - 577
• Main Authors: Foerster, Bradley R., MD, Petrou, Myria, MA, MBChB, MS, Lin, Doris, MD, PhD, Thurnher, Majda M., MD, Carlson, Martha D., MD, PhD, Strouse, Peter J., MD, Sundgren, Pia C., MD, PhD
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Mosby, Inc 01.04.2009; Elsevier
• Subjects: Adult and adolescent clinical studies; Biological and medical sciences; Brain Injuries - epidemiology; Brain Injuries - pathology; Child Abuse - diagnosis; Child, Preschool; Developmental Disabilities - epidemiology; Female; General aspects; Humans; Infant; Infant, Newborn; Injuries of the nervous system and the skull. Diseases due to physical agents; Magnetic Resonance Imaging; Male; Medical sciences; Organic mental disorders. Neuropsychology; Pediatrics; Predictive Value of Tests; Prognosis; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Retrospective Studies; Risk Assessment; Tomography, X-Ray Computed; Traumas. Diseases due to physical agents; United States - epidemiology; United States; Diffusion-weighted imaging; NAT; Diffuse axonal injury; MRI; Subarachnoid hemorrhage; Non-accidental trauma; Spin echo; DAI; CT; SE; Computed tomography; Magnetic resonance imaging; SDH; DWI; SAH; Subdural hematoma; Evaluation; Pediatrics; Nervous system diseases; Correlation; Prognosis; Craniocerebral; Evolution; Medical imagery; Nervous system; Review; Head trauma; Bibliographic review
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2008.09.051

Objective To review the clinical presentation and neuroimaging findings in patients with high clinical suspicion for non-accidental trauma (NAT) of the head, to investigate associations between imaging findings and long-term neurologic outcome in abused children. Study design A retrospective review of 57 cases of NAT of the head from a single institution was performed. Neuroimaging studies (computed tomography [CT] and magnetic resonance imaging [MRI]) were reviewed by a senior neuroradiologist, a neuroradiology fellow, and a radiology resident. Clinical history and physical findings, including retinal examination, imaging, and follow-up assessment, were reviewed. Results The mean time between the patient's arrival at the hospital and CT and MRI imaging was 2.9 hours and 40.6 hours, respectively. The most common clinical presentation was mental status changes, seen in 47% of patients. The most common neuroimaging finding was subdural hematoma, seen in 86% of patients. In the 47 patients who underwent both MRI and CT, 1 case of suspected NAT was missed on head CT. CT detected signs of global ischemia in all 11 patients who died (mean time after arrival at the hospital until undergoing CT, 1.1 hours). MRI detected additional signs of injury in patients who developed mild to moderate developmental delay. Conclusion CT was able to detect evidence of NAT of the head in 56 of 57 abused children included in our cohort and predicted severe neurologic injury and mortality. MRI was useful in detecting additional evidence of trauma, which can be helpful in risk stratification for neurologic outcomes as well in providing confirming evidence of repeated injury.