Abusive head trauma: neuroimaging mimics and diagnostic complexities

Sidpra, Jai; Chhabda, Sahil; Oates, Adam; Bhatia, Aashim; Blasér, Susan; Mankad, Kshitij

doi:10.1007/s00247-020-04940-6

Cited by 8 publications

(12 citation statements)

References 157 publications

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“…Volumetric 3D CT reconstructions can aid in differentiation. 2,5 To the authors' knowledge, the rare combination of SSFCI overlying an accessory suture mimicking head trauma has not been previously described. This case demonstrates the need to be cognizant of rare medical mimics when evaluating infants in whom head trauma is suspected to avoid the potentially catastrophic results of over-diagnosing abuse.…”

Section: Discussionmentioning

confidence: 94%

“…Inflicted head injury is the commonest cause of traumatic fatality in young infants and protective intervention is mandatory if suspected. 2 In pre-mobile infants or those without a history of accidental trauma presenting with signs of head trauma, appropriate forensic investigation should be undertaken and a report to Child Protection is usually indicated. Families often report feeling scrutinised and accused and experience distress when their infant is required to undergo invasive forensic tests and investigations.…”

Section: Discussionmentioning

confidence: 99%

“…Accessory sutures are commonly seen in the parietal and occipital bones and the parietal bone is also the most common location for fractures in infancy. 2 Radiological features can be used to distinguish between the two as accessory sutures have sclerotic borders and tend to be more irregular in outline, while fractures typically lack a sclerotic margin, appearing sharp-edged. Volumetric 3D CT reconstructions can aid in differentiation.…”

Section: Discussionmentioning

confidence: 99%

“…Outside the immediate post‐natal period, scalp swelling most commonly results from trauma, including direct impact or, in the case of subgaleal haemorrhage, forceful hair pulling. Inflicted head injury is the commonest cause of traumatic fatality in young infants and protective intervention is mandatory if suspected 2 . In pre‐mobile infants or those without a history of accidental trauma presenting with signs of head trauma, appropriate forensic investigation should be undertaken and a report to Child Protection is usually indicated.…”

Section: Discussionmentioning

confidence: 99%

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A rare combination of findings mimicking inflicted head trauma: A case of spontaneous subaponeurotic fluid collection overlying accessory sutures

Horstman

Stegeman

Tully

2022

J Paediatrics Child Health

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A rare combination of findings mimicking inflicted head trauma: A case of spontaneous subaponeurotic fluid collection overlying accessory sutures

Horstman

Stegeman

Tully

2022

J Paediatrics Child Health

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“…Clinical findings can be quite heterogeneous. Up to 40% of infants diagnosed with AHT do not have any external injuries [ 9 , 10 ]. Health care providers must be aware of the possibility of AHT.…”

Section: Introductionmentioning

confidence: 99%

Neonatal Abusive Head Trauma without External Injuries: Suspicion Improves Diagnosis

et al. 2022

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The term “shaken baby syndrome” has been replaced by “abusive head trauma (AHT)” based on the mechanism of injury. The reported mortality rate of AHT ranges from 10% to 30%. Up to two-thirds of survivors suffer from serious long-term disabilities. Thus, an expeditious and accurate diagnosis is crucial to prevent further abuse that might result in death or serious disabilities. It remains a challenge for physicians to diagnose AHT when parents do not give a history of trauma in preverbal infants without any external signs. Here, we report a case of a 14-day-old boy who presented with a febrile convulsion without evident external injuries nor history of trauma according to his parents. He was diagnosed with AHT based on MRI findings of subacute subdural hemorrhage, multiple cortical hemorrhages, cerebral edema, and diffuse axonal injury. In conclusion, health care providers should keep in mind that the history of trauma provided by the parents or caregivers might not always be true and that reasonable suspicion of abuse is the most important in the diagnosis of AHT, although neuroimaging plays a pivotal role. Reasonable suspicion of AHT in combination with a thorough physical examination, neuroimaging, and skilled neuroradiologist can improve diagnosis and help victims in a timely manner.

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International Consensus Statement on the Radiological Screening of Contact Children in the Context of Suspected Child Physical Abuse

et al. 2023

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ImportancePhysical abuse is a common but preventable cause of long-term childhood morbidity and mortality. Despite the strong association between abuse in an index child and abuse in contact children, there is no guidance outlining how to screen the latter, significantly more vulnerable group, for abusive injuries. Consequently, the radiological assessment of contact children is often omitted, or variably performed, allowing occult injuries to go undetected and increasing the risk of further abuse.ObjectiveTo report an evidence-based and consensus-derived set of best practices for the radiological screening of contact children in the context of suspected child physical abuse.Evidence ReviewThis consensus statement is supported by a systematic review of the literature and the clinical opinion of an internationally recognized group of 26 experts. The modified Delphi consensus process comprised 3 meetings of the International Consensus Group on Contact Screening in Suspected Child Physical Abuse held between February and June 2021.FindingsContacts are defined as the asymptomatic siblings, cohabiting children, or children under the same care as an index child with suspected child physical abuse. All contact children should undergo a thorough physical examination and a history elicited prior to imaging. Contact children younger than 12 months should have neuroimaging, the preferred modality for which is magnetic resonance imaging, and skeletal survey. Contact children aged 12 to 24 months should undergo skeletal survey. No routine imaging is indicated in asymptomatic children older than 24 months. Follow-up skeletal survey with limited views should be performed if abnormal or equivocal at presentation. Contacts with positive findings should be investigated as an index child.Conclusions and RelevanceThis Special Communication reports consensus recommendations for the radiological screening of contact children in the context of suspected child physical abuse, establishing a recognized baseline for the stringent evaluation of these at-risk children and providing clinicians with a more resilient platform from which to advocate for them.

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Abusive head trauma: neuroimaging mimics and diagnostic complexities

Cited by 8 publications

References 157 publications

A rare combination of findings mimicking inflicted head trauma: A case of spontaneous subaponeurotic fluid collection overlying accessory sutures

A rare combination of findings mimicking inflicted head trauma: A case of spontaneous subaponeurotic fluid collection overlying accessory sutures

Neonatal Abusive Head Trauma without External Injuries: Suspicion Improves Diagnosis

International Consensus Statement on the Radiological Screening of Contact Children in the Context of Suspected Child Physical Abuse

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