title: Parenchymal Brain Laceration as a Predictor of Abusive Head Trauma.
abstract: OBJECTIVE
  Accurate differentiation of abusive head trauma and accidental head injury in infants and young children is critical and impacts clinical care, patient prognosis, forensic investigations, and medicolegal proceedings. No specific finding seen on cross-sectional brain imaging has been reported to distinguish abusive head trauma from accidental injury. Our study investigated whether a specific imaging finding, parenchymal brain laceration, is unique to children diagnosed with abusive head trauma.
  
  
  METHODS
  We retrospectively identified 137 patients with abusive head trauma and 28 patients who incurred moderate to severe accidental brain injury. Brain MR imaging represented the imaging standard for characterizing intracranial injuries.
  
  
  RESULTS
  Among the abusive head trauma cohort, parenchymal brain lacerations were identified in 18 patients, while none were identified in any patients with accidental injury.
  
  
  CONCLUSIONS
  Our findings are in concurrence with the existing forensic, pathology, and imaging literature, which suggests that parenchymal brain lacerations may be related to abusive injury mechanisms.
authors.affiliation: From the Department of Radiology (L.A.P.), Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire lpalifka@hitchock.org.
authors.forename: L A
authors.identifier: http://orcid.org/0000-0003-3406-3205
authors.initials: LA
authors.lastname: Palifka
authors.affiliation: Division of Child Abuse Pediatrics (L.D.F.), Penn State Milton S. Hershey Children's Hospital, Hershey, Pennsylvania.
authors.forename: L D
authors.identifier: http://orcid.org/0000-0001-5735-3593
authors.initials: LD
authors.lastname: Frasier
authors.affiliation: Division of Pediatric Surgery (R.R.M.), University of Utah, Salt Lake City, Utah.
authors.forename: R R
authors.identifier: http://orcid.org/0000-0003-0906-7108
authors.initials: RR
authors.lastname: Metzger
authors.affiliation: Department of Medical Imaging (G.L.H.), Primary Children's Medical Center, Salt Lake City, Utah.
authors.forename: G L
authors.identifier: http://orcid.org/0000-0003-1727-0683
authors.initials: GL
authors.lastname: Hedlund
mesh_terms: D000059:Accidents; D001930:Brain Injuries / Q000175:diagnosis*; D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D015331:Cohort Studies; D006259:Craniocerebral Trauma / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed