TY  - JOUR
PY  - 2020//
TI  - Head computed tomography in suspected physical abuse: time to rethink?
JO  - Archives of disease in childhood
A1  - Glenn, Kathryn
A1  - Nickerson, Elizabeth
A1  - Bennett, C. Verity
A1  - Naughton, Aideen
A1  - Cowley, Laura Elizabeth
A1  - Morris, Emily
A1  - Murtagh, Una
A1  - Kontos, Katina
A1  - Kemp, Alison Mary
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - BACKGROUND: National guidance recommends CT-head for all children <1 year old with suspected physical abuse, and to be considered for those <2 years old to exclude abusive head trauma.     OBJECTIVES: To investigate whether this guidance is followed, and the associations between clinical presentation and CT findings, to determine whether guidance could be refined.     MATERIALS AND METHODS: A retrospective case note review of all children <2 years old who underwent medical assessment for suspected abuse (2009-2017). Outcome measures were frequency of CT-head, and diagnostic yield of intracranial injury, skull fracture or both.     RESULTS: CT-head was undertaken in 60.3% (152/252) of children <12 months old and 7.8% (13/167) of those aged 12-24 months. The diagnostic yield in children who had a CT-head was 27.1% in children <6 months old, 14.3% in those 6-12 months old (p=0.07) and 42.6% (6/13) in those 12-24 months old. For those with head swelling or neurological impairment, it was 84.2% (32/38). In children <12 months old without these clinical features, the estimated prevalence of occult head injury was 6.1% (7/115). The strongest predictors of an abnormal CT-head were swelling to the head (OR 46.7), neurological impairment (OR 20.6) and a low haemoglobin (OR 11.8).     CONCLUSION: All children <2 years of age with suspected physical abuse and neurological impairment or head swelling should undergo CT-head. Where the technical skills and the requisite expertise to interpret MRI exist, an MRI scan may be the optimal first-line neuroimaging investigation in infants who are neurologically stable with injuries unrelated to the head to minimise cranial radiation exposure.<p />  <p>Language: en</p>
LA  - en
SN  - 0003-9888
UR  - http://dx.doi.org/10.1136/archdischild-2020-320192
ID  - ref1
ER  -