Occult Intracranial Injuries on Computed Tomography (Ct) Head Scans in Infants Investigated for Suspected Physical Abuse: A Retrospective Review

Abstract

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.

Practice Variation in Use of Neuroimaging Among Infants With Concern for Abuse Treated in Children’s Hospitals

“…As imaging practices and definitions of occult head injuries have evolved over time, multiple recent studies suggest yields of less than 10% 31,32,35 or even less than 1%. 36 In our administrative database study, neuroimaging identified intracranial injury or hemorrhage in 3.1% of individuals, similar to the yield identified in a prior retrospective chart review in the setting of extremity fractures. 37 Our data suggest that with current neuroimaging guidance, clinicians across different children's hospitals took disparate approaches to neuroimaging.…”