Abusive head trauma and accidental head injury: a 20-year comparative study of
referrals to a hospital child protection team
#MMPMID26130384
Kelly P
; John S
; Vincent AL
; Reed P
Arch Dis Child
2015[Dec]; 100
(12
): 1123-30
PMID26130384
show ga
AIM: To describe children referred for suspected abusive head trauma (AHT) to a
hospital child protection team in Auckland, New Zealand. METHODS: Comparative
review of demographics, histories, injuries, investigations and diagnostic
outcomes for referrals under 15 years old from 1991 to 2010. RESULTS: Records
were available for 345 children. Referrals increased markedly (88 in the first
decade, 257 in the second), but the diagnostic ratio was stable: AHT 60%,
accidental or natural 29% and uncertain cause 11%. The probability of AHT was
similar regardless of socio-economic status or ethnicity. In children under 2
years old with accidental head injuries (75/255, 29%) or AHT (180/255, 71%),
characteristics of particular interest for AHT included no history of trauma
(88/98, 90%), no evidence of impact to the head (84/93, 90%), complex skull
fractures with intracranial injury (22/28, 79%), subdural haemorrhage (160/179,
89%) and hypoxic ischaemic injury (38/39, 97%). In children over 2 years old,
these characteristics did not differ significantly between children with
accidental head injuries (21/47, 45%) and AHT (26/47, 55%). The mortality of AHT
was higher in children over 2 years old (10/26, 38%) than under 2 years (19/180,
11%). CONCLUSIONS: The striking increase in referrals for AHT probably represents
increasing incidence. The decision to refer a hospitalised child with a head
injury for assessment for possible AHT should not be influenced by socio-economic
status or ethnicity. Children over 2 years old hospitalised for AHT are usually
injured by mechanisms involving impact and should be considered at high risk of
death.
|Adolescent
[MESH]
|Autopsy
[MESH]
|Child
[MESH]
|Child Abuse/*diagnosis/statistics & numerical data
[MESH]
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