Nonaccidental head injuries in children: a Sydney experience.
OBJECTIVE
The purpose of this study was to evaluate the demographics, clinical and radiological features, and clinical outcomes of nonaccidental pediatric head injury.


METHODS
The authors reviewed 65 consecutive cases of nonaccidental head injury in a single pediatric neurosurgical unit during a period of 7 years. The mean patient age was 8.2 months (range 0.5-46 months). There were 39 boys and 26 girls. A history of abuse was present in 24% of families. There was a high incidence of family disruption, substance abuse, and premature birth. Fathers were the most common perpetrators. Fifteen patients had a Glasgow Coma Scale score of less than 10. Thirty-five patients had seizures on or preceding admission. Subdural hematoma was the most common finding (81.5%). Skull fractures were present in 36.9% of patients, skeletal injuries in 50% (of which 67% were subclinical), and retinal hemorrhages in 59%. The radiological finding of ischemia or edema had a significant correlation with a poor outcome. Magnetic resonance imaging revealed additional pathological findings not visible on computerized tomography scanning in 18 (49%) of 37 cases. Surgery was performed in 17 patients; recurrence of the subdural collection occurred in 46% of them. In this group, reevacuations were followed by further recurrences, and a subdural-peritoneal shunt was eventually required. Four patients died. Of the 56 surviving patients reviewed on a long-term basis, 19 made a full recovery, and epilepsy was reported in 17%.


CONCLUSIONS
Magnetic resonance imaging should be routinely used in depicting ischemia, which is associated with a poor outcome. The high incidence of subclinical skeletal injuries stresses the importance of assessment of suspected cases of nonaccidental trauma with skeletal surveys and bone scans. Recurrence of subdural collection following burr hole drainage is common and is best treated with a subdural-peritoneal shunt.
Ghahreman
Ali
A
Department of Neurosurgery, The Childrens' Hospital at Westmead, University of Sydney, New South Wales, Australia.
Bhasin
Vishal
V
Chaseling
Raymond
R
Andrews
Bronwyn
B
Lang
Erhard W
EW
D002649:Child Abuse; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006408:Hematoma, Subdural / Q000209:etiology / Q000473:pathology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000209:etiology; D019966:Substance-Related Disorders; D014057:Tomography, X-Ray Computed