title: Inflicted versus accidental head injury in critically injured children.
abstract: OBJECTIVE
  To assess the frequency of inflicted head injury in critically injured children; the severity of neurologic injury; the neurologic outcome; and the historical, socioeconomic, physical, and radiologic factors associated with inflicted head injury.
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  Multidisciplinary pediatric intensive care unit (ICU).
  
  
  METHODS
  Consecutive cases (n = 40) of severe head injury admitted to a pediatric ICU.
  
  
  METHODS
  None.
  
  
  RESULTS
  Fourteen (35%) of 40 cases of head injury were due to inflicted head injury. Eleven (79%) of 14 inflicted head injury cases were due to child abuse and three (21%) were due to neglect. The severity of neurologic injury, as measured by the admission Glasgow Coma Scale, was worse in cases of inflicted head injury (7.1 +/- 0.7 [SE] [inflicted] vs. 9.9 +/- 0.8 [accidental]; p = .04). Glasgow Outcome Scores were worse after inflicted head injury (2 +/- 1 inflicted] vs. 4 +/- 1 [accidental]; p = .004). In victims of child abuse, we found the combination of any two of the following three factors was associated with inflicted head injury: an inconsistent history/physical examination; retinal hemorrhages; or parental risk factors (alcohol or drug abuse, previous social service intervention within the family, or a past history of child abuse or neglect).
  
  
  CONCLUSIONS
  This study confirms that severity of neurologic injury and neurologic outcome in cases of inflicted head injury are worse than in any other type of childhood head injury. We believe that a combination of any two of the above three risk factors may prove to be a reliable marker of inflicted head injury in children admitted to a pediatric ICU and will lead to an early and definitive diagnosis.
authors.affiliation: Department of Pediatrics, University of Rochester, School of Medicine, NY.
authors.forename: B
authors.initials: B
authors.lastname: Goldstein
authors.forename: M M
authors.initials: MM
authors.lastname: Kelly
authors.forename: D
authors.initials: D
authors.lastname: Bruton
authors.forename: C
authors.initials: C
authors.lastname: Cox
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data*; D000367:Age Factors; D000437:Alcoholism / Q000453:epidemiology; D002648:Child; D002649:Child Abuse / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D016638:Critical Illness; D003937:Diagnosis, Differential; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008279:Magnetic Resonance Imaging; D008297:Male; D008487:Medical History Taking; D010290:Parents; D010348:Patient Care Team; D010808:Physical Examination; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012166:Retinal Hemorrhage / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D012947:Social Work; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D014057:Tomography, X-Ray Computed