Non-accidental subdural haemorrhage in Hong Kong: incidence, clinical features, management and outcome.
OBJECTIVE
We aim to identify the incidence and the characteristics of non-accidental subdural haemorrhage in Hong Kong in children under the age of 5 years.


METHODS
Eighteen children aged below 5 years presented with subdural haemorrhage without a history of significant trauma were studied. Clinical features and the work-up process for probable child abuse were analysed.


RESULTS
Sixteen combined case conferences were held, and eleven cases were concluded to be genuine child abuse cases of non-accidental head injury (incidence=1.5 per 100,000 children <5 years old per year). Among these cases, the most common presentation in the younger age group (age<1 year) was seizure (5/7), whilst that in the older age group (age 1-4 years) was coma (4/4, two of these patients also had seizure). One patient in the younger age group and three (3/4) of the older age group were found to have multiple unexplained bruises, suggesting that, in older children, direct impact injury played an important role. Five (5/7) children in the younger age group and all four children in the older age group had retinal haemorrhage. Coma on admission was associated with an unfavourable outcome (6/7 vs 0/4, p=0.015).


CONCLUSIONS
Sixty-one percent of childhood subdural haemorrhage (11/18) without a history of significant trauma were genuine child abuse cases and should all be investigated for probable "non-accidental injury". An organised protocol involving a multi-disciplinary team is mandatory.
Sun
David T F
DT
Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories East, Hong Kong.
Zhu
X L
XL
Poon
W S
WS
D000367:Age Factors; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006408:Hematoma, Subdural / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome