Subdural haemorrhages in infants: population based study.
OBJECTIVE
To identify the incidence, clinical outcome, and associated factors of subdural haemorrhage in children under 2 years of age, and to determine how such cases were investigated and how many were due to child abuse.


METHODS
Population based case series.


METHODS
South Wales and south west England.


METHODS
Children under 2 years of age who had a subdural haemorrhage. We excluded neonates who developed subdural haemorrhage during their stay on a neonatal unit and infants who developed a subdural haemorrhage after infection or neurosurgical intervention.


METHODS
Incidence and clinical outcome of subdural haemorrhage in infants, the number of cases caused by child abuse, the investigations such children received, and associated risk factors.


RESULTS
Thirty three children (23 boys and 10 girls) were haemorrhage. The incidence was 12.8/100 000 children/year (95% confidence interval 5.4 to 20.2). Twenty eight cases (85%) were under 1 year of age. The incidence of subdural haemorrhage in children under 1 year of age was 21.0/100 000 children/year and was therefore higher than in the older children. The clinical outcome was poor: nine infants died and 15 had profound disability. Only 22 infants had the basic investigations of a full blood count, coagulation screen, computed tomography or magnetic resonance imaging, skeletal survey or bone scan, and ophthalmological examination. In retrospect, 27 cases (82%) were highly suggestive of abuse.


CONCLUSIONS
Subdural haemorrhage is common in infancy and carries a poor prognosis; three quarters of such infants die or have profound disability. Most cases are due to child abuse, but in a few the cause is unknown. Some children with subdural haemorrhage do not undergo appropriate investigations. We believe the clinical investigation of such children should include a full multidisciplinary social assessment, an ophthalmic examination, a skeletal survey supplemented with a bone scan or a skeletal survey repeated at around 10 days, a coagulation screen, and computed tomography or magentic resonance imaging. Previous physical abuse in an infant is a significant risk factor for subdural haemorrhage and must be taken seriously by child protection agencies.
Jayawant
S
S
Department of Child Health, University of Wales College of Medicine, Academic Centre, Llandough Hospital, Penarth, Vale of Glamorgan CF64 2XX.
Rawlinson
A
A
Gibbon
F
F
Price
J
J
Schulte
J
J
Sharples
P
P
Sibert
J R
JR
Kemp
A M
AM
D002649:Child Abuse; D004739:England / Q000453:epidemiology; D005260:Female; D006408:Hematoma, Subdural / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D010808:Physical Examination; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014852:Wales / Q000453:epidemiology