Citation

John SM, Kelly P, Vincent A. J. Trauma Acute Care Surg. 2013; 74(1): 276-281.

Affiliation

From the Department of Neurosurgery (S.M.J.), Auckland Hospital Auckland District Health Board, Auckland, New Zealand; Department of Pediatrics (P.K.), Auckland Starship Children's Hospital Auckland District Health Board, Auckland, New Zealand; Te Pua Ruruhau (P.K.) Auckland District Health Board, Auckland, New Zealand; Eye Department (A.V.), Auckland, New Zealand. Greenlane Clinical Centre, Faculty of Medical and Health Sciences, University of Auckland New Zealand; and Department of Ophthalmology (A.V.), New Zealand National Eye Centre, Auckland, New Zealand.

Copyright

(Copyright © 2013, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0b013e318270d82e

PMID

23147184

Abstract

BACKGROUND: Abusive head injury is a major contributor to morbidity and mortality in infants and toddlers, but data comparing patterns of injury in corroborated accidental trauma and confessed child abuse are scarce. METHODS: This is a retrospective review of head injuries with abnormal neuroimaging in children younger than 3 years during a 10-year period in Auckland, New Zealand. Histories were assumed to be true. Results were analyzed for incongruity then compared with data on confessed abuse and corroborated accidental injury. RESULTS: Five hundred nineteen cases were analyzed. Most cases were congruent with the history, and their pattern was consistent with the literature on accidental head trauma in childhood. However, a spike of subdural hemorrhage was seen in the first 6 months of life, explained neither by mechanism nor by published data on birth trauma. The age distribution of retinal hemorrhage was also inconsistent with published data on birth trauma. In infants younger than 6 months, retinal and subdural hemorrhages were associated with the absence of a history of trauma. In older children (6 months-3 years), subdural hemorrhage was more common after minor falls (<1 m, 49%) than major falls (>2 m, 20%) (p = 0.002). CONCLUSION: We conclude that when a young child (particularly an infant younger than 6 months) presents with traumatic intracranial pathology and either no history of trauma or a history of a minor fall, it must be seriously considered that the history is false. LEVEL OF EVIDENCE: Observational study, case series, level III.

Language: en