Clinical and radiographic characteristics associated with abusive and nonabusive head trauma: a systematic review.
OBJECTIVE
To systematically review the literature to determine which clinical and radiographic characteristics are associated with abusive head trauma (AHT) and nonabusive head trauma (nAHT) in children.


METHODS
We searched MEDLINE, EMBASE, PubMed, conference proceedings, and reference lists to identify relevant studies. Two reviewers independently selected studies that compared clinical and/or radiographic characteristics including historical features, physical exam and imaging findings, and presenting signs or symptoms in hospitalized children ≤ 6 years old with AHT and nAHT.


RESULTS
Twenty-four studies were included. Meta-analysis was complicated by inconsistencies in the reporting of characteristics and high statistical heterogeneity. Notwithstanding these limitations, there were 19 clinical and radiographic variables that could be meta-analyzed and odds ratios were determined for each variable. In examining only studies deemed to be high quality, we found that subdural hemorrhage(s), cerebral ischemia, retinal hemorrhage(s), skull fracture(s) plus intracranial injury, metaphyseal fracture(s), long bone fracture(s), rib fracture(s), seizure(s), apnea, and no adequate history given were significantly associated with AHT. Epidural hemorrhage(s), scalp swelling, and isolated skull fracture(s) were significantly associated with nAHT. Subarachnoid hemorrhage(s), diffuse axonal injury, cerebral edema, head and neck bruising, any bruising, and vomiting were not significantly associated with either type of trauma.


CONCLUSIONS
Clinical and radiographic characteristics associated with AHT and nAHT were identified, despite limitations in the literature. This systematic review also highlights the need for consistent criteria in identifying and reporting clinical and radiographic characteristics associated with AHT and nAHT.
Department of Pediatrics, Kingston General Hospital, Queen's University, 76 Stuart St, Kingston, Ontario, Canada K7L 2V7. 7sjp2@queensu.ca
Shalea J
SJ
Piteau
Michelle G K
MG
Ward
Nick J
NJ
Barrowman
Amy C
AC
Plint
D001930:Brain Injuries / Q000175:diagnosis / Q000453:epidemiology; D002649:Child Abuse / Q000175:diagnosis* / Q000706:statistics & numerical data; D002675:Child, Preschool; D015331:Cohort Studies; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination; D010808:Physical Examination; D012680:Sensitivity and Specificity; D012887:Skull Fractures / Q000175:diagnosis* / Q000453:epidemiology; D014057:Tomography, X-Ray Computed