Nonaccidental head trauma as a cause of childhood death.
OBJECTIVE
The authors present the demographic and clinical information in 36 children who died as a result of abusive head trauma at a Level 1 pediatric trauma center between January 1, 1997, and January 1, 2004.


METHODS
Abusive head trauma was defined as radiographic evidence of intracranial injury and documentation from a multidisciplinary child protection team that the injury was nonaccidental. There was no sex bias for the children in the 1st year of life (nine girls, nine boys). In children older than 1 year of age, boys were much more likely to be victims (14 boys, four girls). At the time of admission, every child exhibited a seriously impaired level of consciousness and 81% had retinal hemorrhages. Injuries to other organ systems were rare (17%). The most common abnormality found on neuroimaging studies was subdural hematoma. Six children underwent craniotomy for extraaxial hematomas. Death occurred within 24 hours after hospital admission in one half of the cases.


CONCLUSIONS
Abusive head trauma was the cause of death in 36 (86%) of the 42 children whose deaths were classified as nonaccidental at the Children's Hospital in Denver between 1997 and 2003. The authors were unable to identify anything that could have been done from a medical or neurosurgical viewpoint to prevent the deaths of these children after they came to medical attention.
Graupman
Patrick
P
Division of Neurosurgery and Department of Pediatrics, The University of Vermont School of Medicine, Burlington 05401, USA. patrick.graupman@uvm.edu
Winston
Ken R
KR
D000293:Adolescent; D001497:Battered Child Syndrome / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D001930:Brain Injuries / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D002423:Cause of Death; D002648:Child; D002649:Child Abuse / Q000175:diagnosis / Q000331:legislation & jurisprudence / Q000401:mortality*; D002675:Child, Preschool; D003120:Colorado; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D009460:Neurologic Examination / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers