title: Head injury pattern in children can help differentiate accidental from non-accidental trauma.
abstract: OBJECTIVE
  Our aim was to define the radiographic findings that help differentiate abusive head trauma (AHT) from accidental head injury.
  
  
  METHODS
  Our trauma registry was queried for all children ≤5 years of age presenting with traumatic brain injury (TBI) from 1996-2011.
  
  
  RESULTS
  Of 2,015 children with TBI, 71% had accidental injury and 29% had AHT. Children with AHT were more severely injured (ISS 22.1 vs 14.4; p < 0.0001) and had a higher mortality rate (15 vs 5%; p < 0.0001). Patients with AHT had higher rates of diffuse axonal injury (14 vs 8%; p < 0.0001) and subdural hemorrhage (76 vs 23%; p < 0.0001). Children with accidental injury had higher rates of skull fractures (52 vs 21%; p < 0.0001) and epidural hemorrhages (11 vs 3%).
  
  
  CONCLUSIONS
  AHT occurred in 29% of children and resulted in increased mortality rates. These children had higher rates of subdural hemorrhages and diffuse axonal injury. Physicians initially evaluating injured children must maintain a high index of suspicion for abuse in those who present with subdural hematoma or diffuse axonal injury.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, 13123 E 16th Ave, B323, Aurora, CO, 80045, USA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Roach
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Acker
authors.forename: Denis D
authors.initials: DD
authors.lastname: Bensard
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Sirotnak
authors.forename: Frederick M
authors.initials: FM
authors.lastname: Karrer
authors.forename: David A
authors.initials: DA
authors.lastname: Partrick
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data*; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D002649:Child Abuse / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003120:Colorado / Q000453:epidemiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012042:Registries / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000379:methods*