Infantile subdural hematoma in Japan: A multicenter, retrospective study by the J-HITs (Japanese head injury of infants and toddlers study) group

Abstract

Objective Subdural hematoma in infants or toddlers has often been linked to abuse, but it is not clear how many cases actually occur and how many are suspected of abuse. The purpose of this study was to investigate subdural hematoma in infants and toddlers in Japan. Methods This multicenter, retrospective study reviewed the clinical records of children younger than 4 years with head trauma who were diagnosed with any finding on head computed tomography (CT) and/or magnetic resonance imaging (MRI), such as skull fracture and/or intracranial injury. A total of 452 children were included. The group suspected to have been abused was classified as nonaccidental, and the group considered to have been caused by an accident was classified as accidental. Subdural hematoma and other factors were examined on multivariate analysis to identify which factors increase the risk of nonaccidental injuries. Results Of the 452 patients, 158 were diagnosed with subdural hematoma. Subdural hematoma was the most common finding intracranial finding in head trauma in infants and toddlers. A total of 51 patients were classified into the nonaccidental group, and 107 patients were classified into the accidental group. The age of patients with subdural hematoma showed a bimodal pattern. The mean age of the accidental group with subdural hematoma was significantly older than that in the nonaccidental group (10.2 months vs 5.9 months, respectively. p < 0.001). Multivariate analysis showed that patients under 5 months old, retinal hemorrhage, and seizure were significant risk factors for nonaccidental injury (odds ratio (OR) 3.86, p = 0.0011; OR 7.63, p < 0.001; OR 2.49, p = 0.03; respectively). On the other hand, the odds ratio for subdural hematoma was 1.96, and no significant difference was observed (p = 0.34). Conclusions At least in Japanese children, infantile subdural hematoma was frequently observed not only in nonaccidental but also in accidental injuries. In infants with head trauma, age, the presence of retinal hemorrhage, and the presence of seizures should be considered when determining whether they were abused. Subdural hematoma is also a powerful finding to detect abuse, but care should be taken because, in some ethnic groups, such as the Japanese, there are many accidental cases.

Clinical and neuroimaging characteristics in mild-type infantile acute subdural hematoma. Report of four cases

“…IASDH has a limited age distribution, occurring chie y between age 6 months and 10 months, when infants normally begin sitting or standing [1,9] As in previous, Japanese cases, all the infants in the present report immediately began crying on striking their head, indicating the presence of a lucid interval. Most patients with IASDH present a benign clinical course.…”

Correlations of intracranial pathology and cause of head injury with retinal hemorrhage in infants and toddlers: A multicenter, retrospective study by the J-HITs (Japanese Head injury of Infants and Toddlers study) group

“…Patients with no imaging findings, patients with only extracranial findings, and patients with no apparent findings on imaging were excluded. Two university hospitals, two children's hospitals, and two general hospitals participated in this study, which made the data more similar to the actual situation in Japan [6,7]. A total of 452 children were included in the study.…”

“…Of the 452 patients enrolled in J-HITS [6], those who did not undergo ophthalmological examinations were excluded, and 239 patients with fundal findings were included in this study. From the medical records, sex, age at injury, mechanism of injury, physical and neurological findings, radiological findings, presence of retinal hemorrhage, notification to the Child Guidance Center, temporary custody by the child guidance center, and confirmed criminal cases were extracted.…”

Clinical and neuroimaging characteristics in mild-type infantile acute subdural hematoma: a report of four cases

“…Recent Japanese reports demonstrate that patients suffering from IASDH, particularly the mild form, can be distinguished from those with abusive head trauma (AHT) through multidisciplinary assessment, including evaluation by a child abuse pediatrician [1,9]. Mild-type IASDH is the most common form, constituting more than half of IASDH cases, and is recognized as a benign clinical entity in Japan.…”