Child head injuries: review of pattern from abusive and unintentional causes resulting in hospitalization.
OBJECTIVE
Comparison of patterns of hospitalized child head injuries among unintentionally injured with intentional Shaken Baby Syndrome and Abused victims.


METHODS
Medical records of children birth to 4 years of age admitted to the Fletcher Allen Health Care Hospital in the years 1993 to 1999 for head injury due to any cause were reviewed. Reviews which included age, gender, site of injury, caretaker of child, mechanism of injury, time of injury, severity of injury, CNS sequelae, and quality of investigation were completed for each child.


RESULTS
Of the total of 85 records reviewed, 49 were male and 36 female with a mean age of 18.9 months. Seventy-three children were injured unintentionally. Twelve were victims of intentional actions. Fifty-three percent of the unintentionally injured were male and 83% of the abused were male. Falls caused 53%, motor vehicles 17%, abuse 14%, of all the 85 hospitalized children. Only three deaths occurred among the 85 children, all from motor vehicle crashes. Forty-two percent of the 12 abused victims suffered serious CNS injury compared to only 10% among the unintentionally injured. Earlier symptoms and signs of abuse were missed in four of the 12 abused children.


CONCLUSIONS
Demographic patterns of children hospitalized in Vermont for head injuries are similar to other state and national studies. Severity of injury is significantly higher for abused children. Primary health care providers should receive training emphasizing higher diagnostic index of suspicion for abusive head injuries.
Dept. of Pediatrics, University of Vermont College of Medicine, USA. bro1406@acsalaska.net
George W
GW
Brown
Patrick
P
Malone
D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D038642:Shaken Baby Syndrome / Q000175:diagnosis* / Q000453:epidemiology; D014707:Vermont / Q000453:epidemiology