Subdural haematoma and effusion in infancy: an epidemiological study.
OBJECTIVE
To determine incidence, aetiology, and clinical features of subdural haematoma and effusion (SDH/E) in infancy throughout the British Isles.


METHODS
Cases were notified to the British Paediatric Surveillance Unit over 12 months by paediatricians, neurosurgeons, and paediatric and forensic pathologists.


RESULTS
A total of 186 infants (121 boys, 65 girls) aged 0-2 years were identified. Annual incidence of SDH/E for the UK and Republic of Ireland is 12.54/100,000 aged 0-2 (95% CI 10.3 to 14.62) and 24.1/100,000 aged 0-1 (95% CI 20.89 to 28.18). A total of 106 infants suffered non-accidental head injury (NAHI), 7 accidental head injury, 26 a perinatal cause, 7 a non-traumatic medical condition, 23 meningitis, and in 17 the cause was undetermined; 35 infants died. Significant differences were found in injury pattern, body weight, and Townsend score between NAHI and SDH/E from other cause. There were fewer diagnostic investigations in non-NAHI cases. Delay in diagnosis of greater than a week occurred in 48/181.


CONCLUSIONS
SDH/E is a significant cause of morbidity and mortality in infancy. NAHI is the predominant cause of SDH/E. SDH/E can present in a non-specific and varied way and must be considered in any infant who is unwell. Determining the cause of the SDH/E in some cases continues to present a diagnostic challenge.
Hobbs
C
C
Community Paediatrics, St James's University Hospital, Leeds, UK. chris.hobbs@leedsth.nhs.uk
Childs
A-M
AM
Wynne
J
J
Livingston
J
J
Seal
A
A
D002649:Child Abuse / Q000175:diagnosis; D006259:Craniocerebral Trauma / Q000150:complications; D003937:Diagnosis, Differential; D005260:Female; D006408:Hematoma, Subdural / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007494:Ireland / Q000453:epidemiology; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications / Q000175:diagnosis; D012307:Risk Factors; D012959:Socioeconomic Factors; D013353:Subdural Effusion / Q000453:epidemiology* / Q000209:etiology; D006113:United Kingdom / Q000453:epidemiology