No abstract

BackgroundUK national guidelines recommend that investigation of infants (aged <12 months) with suspected physical abuse should always include CT head scans. Such imaging carries small but recognised risks from radiation exposure. Studies report a range of yields for occult intracranial injuries in suspected physical abuse.AimsTo report the yield of intracranial injuries on CT head scans carried out for suspected physical abuse in infants, compare yields for those presenting with or without signs of head injury and to describe selected clinical and radiological features.MethodsA retrospective cross-sectional review of case records of infants undergoing skeletal survey for suspected physical abuse in Wessex, England. The main outcome measure was yield of intracranial injuries on CT head scan.ResultsIn total, n=363 CT head scans were included (n=275 aged <6 months). The overall yield of intracranial injury was 37 (10%). Among 68 infants presenting with neurological signs or skull fractures, yield was 36 (53%) compared with just 1 (0.34%) of 295 without neurological signs or skull fractures. This one intracranial injury was found to be consistent with an accidental fall. Scalp injury was the only additional clinical feature associated with intracranial injury.ConclusionIn suspected physical abuse, CT head scans should be carried out in infants who present with neurological signs, skull fractures or scalp injuries. However, in balancing potential risks and benefits, we question the value of performing a CT head scan in every infant investigated for suspected physical abuse.

Background United Kingdom national guidelines recommend that investigation of infants (aged <12 months) with suspected physical abuse should always include computed tomography (CT) head scans. Studies report a range of yields for occult intracranial injuries in infants. Aims To gauge the yield of occult intracranial injuries on CT head scans in infants who underwent radiological investigations for suspected physical abuse, and compare selected demographic, clinical and radiological features in infants with and without intracranial injuries. Method A retrospective cross-sectional review of infants investigated for suspected physical abuse in Wessex, England. The main outcome measure was yield of occult intracranial injuries on CT head scan. Occult injuries were defined as previously unsuspected CT head scan findings of postnatal intracranial injury. Results Of 363 CT head scans meeting study criteria, 68 were in infants with neurological signs or skull fractures, 36 of these had intracranial injuries. Of the 295 without neurological signs or skull fractures, just 1 infant had CT features of an intracranial injury. This was the only occult intracranial injury found. It was a small cortical haemorrhage found to be consistent with a contracoup injury from an accidental fall. No additional demographic, clinical or radiological features were associated with intracranial injury. Conclusion In suspected physical abuse, CT head scans should be carried out in infants who present with neurological signs, or who have skull fractures identified on X-ray. However, we question the benefit of performing CT head scans routinely in infants who have no signs of head injury.